Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | MD 17792 | OR |
NPI | 1003811373 |
---|---|
Provider Name | Kevin J Jamison |
First Address | Portland, OR 97208-3158 |
Second Address | Oregon City, OR 97045-2551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 02/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
075023 | (05) | OR |
G01345 | (02) |