Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | D0085556 | MD |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD192938 | OR |
NPI | 1366718116 |
---|---|
Provider Name | Lara Chamberlain Atwater |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2012 |
Last Update Date | 12/11/2019 |