Provider Demographics
NPI:1376748434
Name:V. JAMES MAKKER M.D.,M.B.A., P.C
Entity Type:Organization
Organization Name:V. JAMES MAKKER M.D.,M.B.A., P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MAKKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-253-4000
Mailing Address - Street 1:PO BOX 16130
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97292-0130
Mailing Address - Country:US
Mailing Address - Phone:503-808-9001
Mailing Address - Fax:503-808-9002
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:347
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:503-253-4000
Practice Address - Fax:503-253-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132725Medicare ID - Type Unspecified