Provider Demographics
NPI:1174505044
Name:TAHER, MOHAMMED A (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:A
Last Name:TAHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 SE 8TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4253
Mailing Address - Country:US
Mailing Address - Phone:503-681-4233
Mailing Address - Fax:503-681-4234
Practice Address - Street 1:364 SE 8TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4253
Practice Address - Country:US
Practice Address - Phone:503-681-4233
Practice Address - Fax:503-681-4234
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288159Medicaid
ORH21643Medicare UPIN
139784Medicare PIN