Provider Demographics
NPI:1346200524
Name:OKON, NICHOLAS J (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:J
Last Name:OKON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 NW KEARNEY ST
Mailing Address - Street 2:#727
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2755
Mailing Address - Country:US
Mailing Address - Phone:206-604-8142
Mailing Address - Fax:
Practice Address - Street 1:1410 NW KEARNEY ST
Practice Address - Street 2:#727
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2755
Practice Address - Country:US
Practice Address - Phone:206-604-8142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVD015942084N0400X
ORDO291522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1346200524Medicaid
OR500605951Medicaid
NV1346200524Medicaid
OR500605951Medicaid
ORR146640Medicare PIN