Healthcare Provider Details

I. General information

NPI: 1366592214
Provider Name (Legal Business Name): NORMAN TOSHIAKI EKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 NE BURNSIDE RD STE 503C
GRESHAM OR
97030-5770
US

IV. Provider business mailing address

644 SW WALTERS DR
GRESHAM OR
97080-9351
US

V. Phone/Fax

Practice location:
  • Phone: 971-888-2014
  • Fax: 971-206-6387
Mailing address:
  • Phone: 971-888-2014
  • Fax: 971-206-6387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD13275
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: