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General NPI Number Information
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NPI Number | 1649312398
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Entity Type | Organization
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Legal Business Name | IVAN P LAW MD PC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 2707 NE 33RD AVE
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City | PORTLAND
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State | OR
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Zip | 97212-3649
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Country | US
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Telephone | 503-288-5067
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Fax | 503-282-9670
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Provider Business Mailing Address
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Address Line | 2707 NE 33RD AVE
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City | PORTLAND
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State | OR
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Zip | 97212-3649
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Country | US
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Telephone | 503-288-5067
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Fax | 503-282-9670
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | MR. IVAN PE LAW
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Credential | MD
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Telephone | 503-288-5067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | MD10631
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License Number State | OR
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