Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD170115 | OR |
Y | 2080P0205X | Pediatric Endocrinologist | MD170115 | OR |
NPI | 1144287848 |
---|---|
Provider Name | Mr. Michael Racine |
First Address | Roseburg, OR 97471-6214 |
Second Address | Roseburg, OR 97471-6214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 19/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500678063 | (05) | OR |
H91680 | (02) |