Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 0880 | OR |
NPI | 1104991678 |
---|---|
Provider Name | Dr. Samantha L Brody |
First Address | Portland, OR 97239 |
Second Address | Portland, OR 97239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 22/10/2007 |