Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO20609 | OR |
NPI | 1154493302 |
---|---|
Provider Name | Thomas Lester Starbard |
First Address | Portland, OR 97205-1902 |
Second Address | Tigard, OR 97223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 25/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138085 | (05) | OR |
I06173 | (02) |