Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | LP01899 | RI |
N | 111NI0900X | Internist | LP01899 | RI |
N | 207R00000X | Internist | ME115594 | FL |
N | 111NI0900X | Internist | ME115594 | FL |
Y | 207RH0000X | Hematologist | MD205893 | OR |
NPI | 1306157458 |
---|---|
Provider Name | Yazan Migdady |
First Address | Portland, OR 97239-4501 |
Second Address | Portland, OR 97239-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 25/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009117200 | (05) | FL |