Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | MD18330 | OR |
NPI | 1013032614 |
---|---|
Provider Name | Rosalie Louise Movius |
First Address | Portland, OR 97223-7475 |
Second Address | Portland, OR 97223-7475 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 18/12/2014 |