Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD27709 | OR |
N | 111NI0900X | Internist | MD27709 | OR |
N | 207RH0000X | Hematologist | MD27709 | OR |
Y | 207RX0202X | Medical Oncology | MD27709 | OR |
NPI | 1447451794 |
---|---|
Provider Name | Shane O Rogosin |
First Address | Portland, OR 97208-3158 |
Second Address | Clackamas, OR 97015-6776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 24/03/2021 |