Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | DO199113 | OR |
NPI | 1003200908 |
---|---|
Provider Name | Katy L Bochat |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97213-2984 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2015 |
Last Update Date | 15/01/2021 |