Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD29346 | OR |
N | 208600000X | Surgeon | MD29346 | OR |
N | 2086S0102X | Surgical Critical Care | MD29346 | OR |
Y | 2086S0127X | Trauma Surgeon | MD29346 | OR |
NPI | 1275743353 |
---|---|
Provider Name | Philbert Y Van |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 22/11/2013 |