Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | MD193306 | OR |
Y | 2086S0127X | Trauma Surgeon | MD193306 | OR |
NPI | 1265850762 |
---|---|
Provider Name | Tatiana Hoyos Gomez |
First Address | Madison, WI 53792-0001 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 14/07/2020 |