Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD26727 | OR |
Y | 207ND0900X | Dermatopathologist | MD26727 | OR |
NPI | 1447329719 |
---|---|
Provider Name | Kevin Patrick White |
First Address | Portland, OR 97239-4501 |
Second Address | Portland, OR 97239-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 27/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
240056 | (05) | OR |