Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | MD14690 | OR |
NPI | 1013921469 |
---|---|
Provider Name | Lee Alan Taylor |
First Address | Philadelphia, PA 19178-7642 |
Second Address | Portland, OR 97239-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 16/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD14690 | LICENSE (01) | OR |