Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | D67969 | MD |
N | 208200000X | Surgeon | 4877 | NE |
N | 208600000X | Surgeon | 4877 | NE |
N | 208200000X | Surgeon | D67969 | MD |
N | 208600000X | Surgeon | D67969 | MD |
N | 208200000X | Surgeon | MD190242 | OR |
N | 208600000X | Surgeon | MD190242 | OR |
Y | 2086S0102X | Surgical Critical Care | MD190242 | OR |
NPI | 1124232079 |
---|---|
Provider Name | Dr. Nicholas Jaszczak |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 31/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
417807600 | (05) | MD |