Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD20521 | OR |
N | 207QS0010X | Family Doctor - Sports Medicine | MD20521 | OR |
NPI | 1295773901 |
---|---|
Provider Name | Pamela J Irby |
First Address | Redmond, OR 97756-0400 |
Second Address | Redmond, OR 97756-1357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 23/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11131153 | CAQH ID (01) | OR |
158487 | (05) | OR |