Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD162819 | OR |
N | 207VX0201X | Gynecologic Oncologist | 35280 | IA |
Y | 207VX0201X | Gynecologic Oncologist | MD162819 | OR |
NPI | 1093702862 |
---|---|
Provider Name | Koenraad De Geest |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 20/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0422592 | (05) | IA |
35627 | WELLMARK BCBS (01) | IA |
E43576 | (02) |