Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 126262 | OR |
N | 207RR0500X | Rheumatology | A74929 | CA |
NPI | 1003907601 |
---|---|
Provider Name | Kenneth John Scalapino |
First Address | Portland, OR 97239-2964 |
Second Address | Portland, OR 97239-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 26/01/2010 |