Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD15344 | OR |
NPI | 1134198914 |
---|---|
Provider Name | Patrick L Hanley |
First Address | Portland, OR 97216-2448 |
Second Address | Portland, OR 97216-2448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 26/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
152355 | (05) | OR |
C92801 | (02) | OR |