Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | MD00045150 | WA |
Y | 207T00000X | Neurosurgeon | MD25930 | OR |
NPI | 1043373996 |
---|---|
Provider Name | Dr. Richard Sanders Polin |
First Address | Portland, OR 97221-3228 |
Second Address | Clackamas, OR 97015-9750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G76007 | (02) |