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General NPI Number Information
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NPI Number | 1891370771
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Entity Type | Organization
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Legal Business Name | OREGON HEALTH ENDOCRINOLOGY
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Dates
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Enumeration Date | 03/12/2021
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 6475 SW BORLAND RD STE L
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City | TUALATIN
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State | OR
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Zip | 97062-9708
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Country | US
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Telephone | 732-895-2527
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Fax |
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Provider Business Mailing Address
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Address Line | 19365 SW 65TH AVE STE 105
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City | TUALATIN
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State | OR
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Zip | 97062-9196
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Country | US
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Telephone | 503-506-8500
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Fax |
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Authorized Official
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Title or Position | PART OWNER
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Name | YUSUF MATHAI
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Credential | MD
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Telephone | 732-895-2527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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