Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD21432 | OR |
N | 207ND0900X | Dermatopathologist | MD21432 | OR |
N | 207NS0135X | Procedural Dermatology | MD21432 | OR |
NPI | 1508999152 |
---|---|
Provider Name | Paul A Klas |
First Address | Portland, OR 97281-3200 |
Second Address | Tualatin, OR 97062-8353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 27/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
151278 | (05) | OR |
C74739 | (02) | OR |