Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | DO23628 | OR |
Y | 2080A0000X | Adolescent Medicine | DO23628 | OR |
N | 2080P0006X | Developmental - Behavioral Pediatrician | DO23628 | OR |
NPI | 1265437529 |
---|---|
Provider Name | Michelle F Devoe |
First Address | Ontario, OR 97914 |
Second Address | Ontario, OR 97914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 19/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
806364700 | (05) | ID |
H25559 | (02) |