=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205379096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA DUCORE D.V.M.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2016
-----------------------------------------------------
Last Update Date | 11/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4341 SE ROCKWOOD ST
-----------------------------------------------------
City | MILWAUKIE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97222-5007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-340-8593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4341 SE ROCKWOOD ST
-----------------------------------------------------
City | MILWAUKIE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97222-5007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-340-8593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 7526
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------