Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 27-2898 | OR |
Y | 213ER0200X | Radiology | 27-2898 | OR |
NPI | 1114146891 |
---|---|
Provider Name | Lisa Hoffman |
First Address | Portland, OR 97214-5221 |
Second Address | Portland, OR 97214-5221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |