Individual
DR. MYRNA ANTONIO CASONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
417 SW 117TH AVE, PORTLAND, OR 97225-5924
(503) 216-9400
Mailing address
7947 SW LEISER LN, TIGARD, OR 97224-7401
(503) 303-6906
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
13598
OR
207R00000X
Internal Medicine Physician
Primary
17939
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588666432
—
NV
01
—
17939
NV STATE LICENSE
NV
Enumeration date
08/11/2005
Last updated
06/06/2019
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