Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 6981 | KS |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD167189 | OR |
NPI | 1255590964 |
---|---|
Provider Name | Gustav Fischer |
First Address | Portland, OR 97213-2991 |
Second Address | Portland, OR 97213-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 19/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500677418 | (05) | OR |