Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist |
NPI | 1043324049 |
---|---|
Provider Name | Dr. Peter Jacky |
First Address | Portland, OR 97210-1012 |
Second Address | Portland, OR 97230-1048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |