Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD11601 | OR |
NPI | 1700892312 |
---|---|
Provider Name | Jonathan Zonana |
First Address | Portland, OR 97239-2901 |
Second Address | Portland, OR 97239-2901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 07/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
246215 | (05) | OR |
E99303 | (02) |