Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | MD07659 | OR |
NPI | 1033101167 |
---|---|
Provider Name | Jerzy O Giedwoyn |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97220-9428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 11/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070854 | (05) | OR |
C92710 | (02) | OR |