Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD18414 | OR |
NPI | 1003898339 |
---|---|
Provider Name | James C Faherty |
First Address | The Dalles, OR 97058-3388 |
Second Address | The Dalles, OR 97058-3388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 27/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070875 | (05) | OR |
G25693 | (02) | OR |