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NPI Code Detail

MEDICARE: BRUCE WILSON DANA M.D.

MEDICARE:   BRUCE WILSON DANA  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RX0202XMedical Oncology PhysicianMD10331OR

Other Identifiers

General Provider Information

NPI Number : 1558364570
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRUCE WILSON DANA M.D.
Provider Business Mailing Address
First Line : 5050 NE HOYT ST
Second Line : STE 256
City : PORTLAND
State : OR
Zip : 97213-2982
Country : US
Telephone Number : 503-239-7767
Fax Number : 503-215-6897
Provider Business Practice Location Address
First Line : 5050 NE HOYT ST
Second Line : STE 256
City : PORTLAND
State : OR
Zip : 97213-2982
Country : US
Telephone Number : 503-239-7767
Fax Number : 503-215-6897
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 12/22/2011

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Directions to “ BRUCE WILSON DANA M.D.” Practice Location

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