Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD151140 | OR |
NPI | 1003061805 |
---|---|
Provider Name | Dr. Sharon Sarah Green |
First Address | Portland, OR 97239 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2008 |
Last Update Date | 30/11/2010 |