Provider Demographics
NPI:1558723825
Name:RAHIM, ABDULRAHMAN
Entity Type:Individual
Prefix:
First Name:ABDULRAHMAN
Middle Name:
Last Name:RAHIM
Suffix:
Gender:M
Credentials:
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 1517
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0410
Mailing Address - Country:US
Mailing Address - Phone:877-708-1119
Mailing Address - Fax:
Practice Address - Street 1:6445 N GREELEY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5023
Practice Address - Country:US
Practice Address - Phone:503-285-6607
Practice Address - Fax:503-285-3195
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPG188600207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine