Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | MD23359 | OR |
NPI | 1295761633 |
---|---|
Provider Name | Mary Alice Helikson |
First Address | Portland, OR 97208-4949 |
Second Address | Portland, OR 97225-6652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A13705 | (02) | OR |