Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD-17067 | OR |
NPI | 1104840057 |
---|---|
Provider Name | Randi R. Ledbetter |
First Address | Portland, OR 97225-6625 |
Second Address | Portland, OR 97225-6625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |