Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 174344-1 | NY |
Y | 208000000X | Pediatrician | MD151411 | OR |
NPI | 1003025370 |
---|---|
Provider Name | Dr. Sara Levine Mccaffrey |
First Address | The Dalles, OR 97058 |
Second Address | The Dalles, OR 97058-3213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 20/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128112 | (05) | OR |