Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD28124 | OR |
NPI | 1013005461 |
---|---|
Provider Name | Eric Blaine Kirker |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97225-6640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 15/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
218623 | (05) | OR |