Provider Demographics
NPI:1679752794
Name:SOHRIAKOFF, JAMES ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:SOHRIAKOFF
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 1:527 SE BASELINE ST
Mailing Address - Street 2:STE E
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4149
Mailing Address - Country:US
Mailing Address - Phone:503-648-1121
Mailing Address - Fax:503-648-1124
Practice Address - Street 1:527 SE BASELINE ST
Practice Address - Street 2:STE E
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4149
Practice Address - Country:US
Practice Address - Phone:503-648-1121
Practice Address - Fax:503-648-1124
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO12215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR208090Medicaid
ORR139565Medicare PIN