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General NPI Number Information
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NPI Number | 1316262108
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Entity Type | Individual
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Provider Name | JONATHAN CARNELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 5050 NE HOYT ST STE 625
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City | PORTLAND
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State | OR
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Zip | 97213-2991
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Country | US
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Telephone | 503-731-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 5050 NE HOYT ST STE 625
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City | PORTLAND
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State | OR
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Zip | 97213-2991
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Country | US
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Telephone | 503-731-2900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | MD.60550687
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License Number State | WA
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