Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | MD00041062 | WA |
Y | 207RG0100X | Gastroenterologist | MD21215 | OR |
NPI | 1033222609 |
---|---|
Provider Name | Mr. Jason John Powers |
First Address | Portland, OR 97227-1196 |
Second Address | Portland, OR 97227-1196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 10/07/2007 |