Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD26161 | OR |
N | 111NI0900X | Internist | MD26161 | OR |
Y | 207RA0401X | Internist - Addiction Medicine | MD26161 | OR |
N | 207RG0300X | Geriatric Medicine | MD26161 | OR |
NPI | 1831144872 |
---|---|
Provider Name | Sounak N Misra |
First Address | Portland, OR 97202-1484 |
Second Address | Portland, OR 97217-8130 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 07/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
271033 | (05) | OR |
I50915 | (02) | OR |
P00294103 | RR MEDICARE (01) | OR |