Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | MD00014422 | WA |
NPI | 1083729214 |
---|---|
Provider Name | Dr. Stephen Arnold Ebert |
First Address | Portland, OR 97201 |
Second Address | Portland, OR 97201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 13/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8186702 | (05) | WA |
A15760 | (02) |