Healthcare Provider Details

I. General information

NPI: 1104269711
Provider Name (Legal Business Name): ABBAS NAVROZE ASGERALLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 NE 129TH ST
VANCOUVER WA
98686-3236
US

IV. Provider business mailing address

PO BOX 1600
VANCOUVER WA
98668-1600
US

V. Phone/Fax

Practice location:
  • Phone: 360-546-8950
  • Fax: 360-696-5445
Mailing address:
  • Phone: 360-696-5022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number60835773
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number60835773
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD60835773
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: