Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 5241 | AK |
NPI | 1316006166 |
---|---|
Provider Name | Stephen Cameron |
First Address | Portland, OR 97217-7808 |
Second Address | Portland, OR 97217-7679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2006 |
Last Update Date | 08/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD40901 | (05) | AK |