Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD29208 | OR |
N | 111NI0900X | Internist | MD29208 | OR |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MD29208 | OR |
N | 207RC0000X | Internist - Cardiovascular Disease | MD0048397 | WA |
N | 207RC0000X | Internist - Cardiovascular Disease | MD29208 | OR |
NPI | 1548223381 |
---|---|
Provider Name | Jacob Abraham |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97225-6652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 02/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500609590 | (05) | OR |
P00873816 | RR MEDICARE (01) | OR |
P00991145 | RR MEDICARE (01) | WA |