Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD196981 | OR |
Y | 111NI0900X | Internist | MD196981 | OR |
N | 207R00000X | Internist | MT212992 | PA |
N | 111NI0900X | Internist | MT212992 | PA |
NPI | 1003334368 |
---|---|
Provider Name | Humza Saleem Maqbool |
First Address | Portland, OR 97208-3397 |
Second Address | Seaside, OR 97138-7735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2017 |
Last Update Date | 15/02/2021 |