Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD21788 | OR |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD21788 | OR |
NPI | 1447267372 |
---|---|
Provider Name | Sharon Renee Edwards |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 04/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133968 | (05) | OR |
F55560 | (02) |