Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD18652 | OR |
Y | 208600000X | Surgeon | MD18652 | OR |
N | 2086S0129X | Vascular Surgeon | MD18652 | OR |
N | 208C00000X | Colorectal Surgeon | MD18652 | OR |
NPI | 1063473452 |
---|---|
Provider Name | Milton C Mackett |
First Address | Portland, OR 97216-2448 |
Second Address | Portland, OR 97216-2448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 25/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127220 | (05) | OR |
A39957 | (02) |