Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD24703 | OR |
Y | 208600000X | Surgeon | MD24703 | OR |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD24703 | OR |
NPI | 1235285214 |
---|---|
Provider Name | Samuel Vincent Bartholomew |
First Address | Portland, OR 97232-2684 |
Second Address | Portland, OR 97213-2984 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022461 | (05) | OR |
RES000 | (02) | CA |