Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MD00036102 | WA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD21219 | OR |
NPI | 1588733489 |
---|---|
Provider Name | Stephen Einar Renwick |
First Address | Portland, OR 97225-6652 |
Second Address | Portland, OR 97225-6652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 04/02/2022 |