Individual
DR. PROLETA DATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD PHD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7772
(503) 494-7242
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7772
(503) 494-7242
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
30734
NE
2084N0400X
Neurology Physician
A142041
CA
2084N0400X
Neurology Physician
MD203710
OR
390200000X
Student in an Organized Health Care Education/Training Program
BP10043519
TX
Other
Enumeration date
07/23/2012
Last updated
06/03/2021
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