Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD19185 | OR |
NPI | 1134137664 |
---|---|
Provider Name | Jone Elizabeth Sampson |
First Address | Lake Oswego, OR 97034-3617 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 01/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
069141 | (05) | OR |
E91010 | (02) |