Provider Demographics
NPI:1619938560
Name:AZHAR, NAIYAR (MD)
Entity Type:Individual
Prefix:DR
First Name:NAIYAR
Middle Name:
Last Name:AZHAR
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 1:51721 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-4044
Mailing Address - Country:US
Mailing Address - Phone:503-543-0956
Mailing Address - Fax:
Practice Address - Street 1:500 N COLUMBIA RIVER HWY
Practice Address - Street 2:STE#6
Practice Address - City:ST HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1299
Practice Address - Country:US
Practice Address - Phone:503-397-4449
Practice Address - Fax:503-366-5519
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16512208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR008149Medicaid
OR008149Medicaid