Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD25760 | OR |
N | 207XS0106X | Orthopaedic Hand Surgeon | MD25760 | OR |
NPI | 1144220195 |
---|---|
Provider Name | Jason Tavakolian |
First Address | Eugene, OR 97401-2433 |
Second Address | Eugene, OR 97401-2433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 28/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023191 | (05) | OR |
I31429 | (02) | OR |
P00317978 | MC RAILROAD (01) | OR |