Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125-059840 | IL |
N | 111NI0900X | Internist | 125-059840 | IL |
N | 207RC0000X | Internist - Cardiovascular Disease | MD186847 | OR |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD186847 | OR |
NPI | 1124319330 |
---|---|
Provider Name | Nicholas James Abbott |
First Address | Portland, OR 97208-3777 |
Second Address | Tualatin, OR 97062-7452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2011 |
Last Update Date | 17/09/2021 |