Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD13269 | OR |
NPI | 1124014956 |
---|---|
Provider Name | Kim A Wayson |
First Address | Portland, OR 97225-6625 |
Second Address | Portland, OR 97225-6625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
155754 | (05) | OR |
C94040 | (02) |