Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | DO154327 | OR |
N | 111NI0900X | Internist | DO154327 | OR |
Y | 207RC0200X | Critical Care Medicine | DO154327 | OR |
NPI | 1023213436 |
---|---|
Provider Name | Dr. Tara Lyn Eagle |
First Address | Portland, OR 97277 |
Second Address | Portland, OR 97227-1630 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 06/11/2018 |