Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | MD18061 | OR |
Y | 208000000X | Pediatrician | MD18061 | OR |
NPI | 1154336659 |
---|---|
Provider Name | Markus Charles Paul Grompe |
First Address | Portland, OR 97239-1077 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 28/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
049093 | (05) | OR |
F41695 | (02) |