Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | 3844 | OR |
N | 213ER0200X | Radiology | 3844 | OR |
Y | 111NS0005X | Chiropractic Sports Physician | 3844 | OR |
NPI | 1548686108 |
---|---|
Provider Name | Dr. Sara Mathov |
First Address | Portland, OR 97230-3014 |
Second Address | Portland, OR 97230-3014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2014 |
Last Update Date | 06/03/2014 |