Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | MD193416 | OR |
NPI | 1588939961 |
---|---|
Provider Name | Marcus Aaron Couey |
First Address | Boston, MA 02118-3552 |
Second Address | Portland, OR 97209-1453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2012 |
Last Update Date | 02/10/2021 |