Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | DO23147 | OR |
NPI | 1003836230 |
---|---|
Provider Name | Karen Jeanne O'neill |
First Address | Portland, OR 97239-1938 |
Second Address | Gresham, OR 97030-3378 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
287408 | (05) | OR |
F02509 | (02) |