Dmitriy Shore, PA-C
Physician Assistant, Medical in Portland, OR. Individual provider (NPI-1).
NPI number1124177902
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1124177902
- Entity type
- Individual (NPI-1)
- Name
- Dmitriy Shore
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jan 9, 2007
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | PA00724 | OR | Yes |
Practice location
10305 Sw Park Way Ste 300Portland, OR 97225-5033
Phone 503-295-0730 · Fax 503-295-0731
Mailing address
10305 Sw Park Way Ste 300Portland, OR 97225-5033
Phone 503-295-0730 · Fax 503-295-0731
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