Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | MD22962 | OR |
NPI | 1760574230 |
---|---|
Provider Name | Dr. Robert Louis Cloutier |
First Address | Portland, OR 97239-3098 |
Second Address | Portland, OR 97239-3098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G63952 | (02) | OR |