Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | DO191573 | OR |
Y | 111NI0900X | Internist | DO191573 | OR |
NPI | 1003158700 |
---|---|
Provider Name | Tomer Pelleg |
First Address | Corvallis, OR 97339-1189 |
Second Address | Corvallis, OR 97330-3737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 13/09/2021 |