Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | FE177647 | OR |
NPI | 1265987978 |
---|---|
Provider Name | Mitchell Jon Steele |
First Address | Philadelphia, PA 19178-7642 |
Second Address | Portland, OR 97239-3009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2016 |
Last Update Date | 01/11/2016 |