Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | A130284 | CA |
Y | 207RG0100X | Gastroenterologist | MD174206 | OR |
NPI | 1043484405 |
---|---|
Provider Name | Rebecca Matro |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2008 |
Last Update Date | 15/09/2015 |