Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 14335 | OR |
N | 208D00000X | General Practice Physician | 14335 | OR |
NPI | 1063589323 |
---|---|
Provider Name | Paul E Dart |
First Address | Eugene, OR 97405-4248 |
Second Address | Eugene, OR 97405-4248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
157701 | DMAP (01) | OR |
BD0327759 | DEA (01) | |
C92477 | (02) |