Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | MD08746 | OR |
NPI | 1790721926 |
---|---|
Provider Name | Mathews B Fish |
First Address | Eugene, OR 97402-0451 |
Second Address | Springfield, OR 97477-8800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 30/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
238220 | (05) | OR |