Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | DO181702 | OR |
Y | 111NI0900X | Internist | DO181702 | OR |
NPI | 1003203993 |
---|---|
Provider Name | Patricia Funk |
First Address | Portland, OR 97227-1630 |
Second Address | Portland, OR 97227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2015 |
Last Update Date | 06/08/2018 |