Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD27542 | OR |
NPI | 1235225624 |
---|---|
Provider Name | Matthew C Fedor |
First Address | Salem, OR 97308-0886 |
Second Address | Salem, OR 97301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 11/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
274652 | (05) | OR |
H16815 | (02) | |
R152647 | MEDICARE (01) | OR |