Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD23061 | OR |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 23061 | OR |
NPI | 1255374740 |
---|---|
Provider Name | James S Davitt |
First Address | Portland, OR 97225-5933 |
Second Address | Portland, OR 97225-5914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
229314 | (05) | OR |
H20532 | (02) | OR |
MD23061 | OREGON MEDICAL LICENSE (01) | OR |