Healthcare Provider Details

I. General information

NPI: 1376748434
Provider Name (Legal Business Name): V. JAMES MAKKER M.D.,M.B.A., P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST 347
PORTLAND OR
97213-2991
US

IV. Provider business mailing address

PO BOX 16130
PORTLAND OR
97292-0130
US

V. Phone/Fax

Practice location:
  • Phone: 503-253-4000
  • Fax: 503-253-4002
Mailing address:
  • Phone: 503-808-9001
  • Fax: 503-808-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD23879
License Number StateOR

VIII. Authorized Official

Name: DR. VISHAL JAMES MAKKER
Title or Position: CORPORATE PRESIDENT
Credential: M.D.
Phone: 503-253-4000