Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD16637 | OR |
NPI | 1013919919 |
---|---|
Provider Name | Dr. Scott Roberts Grewe |
First Address | Tigard, OR 97224-7166 |
Second Address | Tigard, OR 97224-7166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 07/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009741 | (05) | OR |
1013919919 | NPI (01) | OR |
E27807 | (02) | OR |