Healthcare Provider Details

I. General information

NPI: 1336144450
Provider Name (Legal Business Name): ALFREDO SABBAJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD MAIL CODE: CDW-EM
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD MAIL CODE: CDW-EM
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-1475
  • Fax: 503-494-4997
Mailing address:
  • Phone: 503-494-1475
  • Fax: 503-494-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD23236
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: