Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 12787 | OR |
NPI | 1013082213 |
---|---|
Provider Name | Mr. Edward G. Atkin |
First Address | Hillsboro, OR 97123-4245 |
Second Address | Hillsboro, OR 97123-4245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 24/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C94196 | (02) |