Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | D10787 | OR |
N | 1223S0112X | Oral and Maxillofacial Surgeon | D9281 | CO |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DE00009207 | WA |
NPI | 1710967252 |
---|---|
Provider Name | Dr. Mariam Alexes Hamidi |
First Address | Camas, WA 98607-1707 |
Second Address | Vancouver, WA 98683-9679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 22/12/2021 |