Provider Demographics
NPI:1255650750
Name:ISIORHO, EJIRO C (DPM)
Entity Type:Individual
Prefix:
First Name:EJIRO
Middle Name:C
Last Name:ISIORHO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11515 SW DURHAM ROAD
Mailing Address - Street 2:E1
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224
Mailing Address - Country:US
Mailing Address - Phone:503-624-0364
Mailing Address - Fax:503-684-3306
Practice Address - Street 1:11515 SW DURHAM ROAD
Practice Address - Street 2:E1
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224
Practice Address - Country:US
Practice Address - Phone:503-624-0364
Practice Address - Fax:503-684-3306
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP161832213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program