Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 5745 | OR |
NPI | 1417403361 |
---|---|
Provider Name | Jacob Plasker |
First Address | Beaverton, OR 97005-0666 |
Second Address | Portland, OR 97225-5923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2016 |
Last Update Date | 20/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5745 | OREGON BOARD OF CHIROPRACTIC EXAMINERS (01) | OR |