Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 16638 | OR |
NPI | 1164592382 |
---|---|
Provider Name | Jana Marie Reddoch |
First Address | Portland, OR 97225 |
Second Address | Portland, OR 97225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
024660 | (05) | OR |
F61252 | (02) |