Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD189727 | OR |
N | 207R00000X | Internist | MD189727 | OR |
N | 111NI0900X | Internist | MD189727 | OR |
NPI | 1114364247 |
---|---|
Provider Name | Shyam Rajan Joshi |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2013 |
Last Update Date | 16/08/2018 |