Provider Demographics
NPI:1306038427
Name:MOHABEER, AJAY JAGARNATH (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:JAGARNATH
Last Name:MOHABEER
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:PO BOX 40127
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-0021
Mailing Address - Country:US
Mailing Address - Phone:817-501-5244
Mailing Address - Fax:503-689-1385
Practice Address - Street 1:18610 NW CORNELL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9204
Practice Address - Country:US
Practice Address - Phone:503-216-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD269002083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine