Healthcare Provider Details

I. General information

NPI: 1619938560
Provider Name (Legal Business Name): NAIYAR AZHAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N COLUMBIA RIVER HWY STE#6
ST HELENS OR
97051-1299
US

IV. Provider business mailing address

51721 SW 3RD ST
SCAPPOOSE OR
97056-4044
US

V. Phone/Fax

Practice location:
  • Phone: 503-397-4449
  • Fax: 503-366-5519
Mailing address:
  • Phone: 503-543-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD16512
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier008149
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: