Provider Demographics
NPI:1427005487
Name:ANSARI, YASMIN (MD)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:ANSARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14471 NW WHISTLER LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-8204
Mailing Address - Country:US
Mailing Address - Phone:503-533-1019
Mailing Address - Fax:
Practice Address - Street 1:9205 SW BARNES RD
Practice Address - Street 2:5TH FLOOR SOUTH
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6603
Practice Address - Country:US
Practice Address - Phone:503-216-2906
Practice Address - Fax:503-216-7106
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23791207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269780Medicaid
ORP00438698OtherRR MEDICARE - PROVIDENCE
ORR161095Medicare PIN
ORT133569Medicare PIN
ORI47292Medicare UPIN
ORR161094Medicare PIN
ORR136355Medicare PIN
OR269780Medicaid