Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | MD61191640 | WA |
NPI | 1033686704 |
---|---|
Provider Name | Dr. Walaa Farouk Ragheb Abdelmoaty |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2018 |
Last Update Date | 11/08/2021 |