Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 171470 | OR |
NPI | 1023307899 |
---|---|
Provider Name | Dr. Thomas Derek Kowalik |
First Address | Hillsboro, OR 97124-5062 |
Second Address | Hillsboro, OR 97124-5062 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2011 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD171470 | LICENSE NUMBER (01) | OR |