Provider Demographics
NPI: | 1851660955 |
---|---|
Name: | EL-BAKRI, HUSAMEDDIN RAWHI (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | HUSAMEDDIN |
Middle Name: | RAWHI |
Last Name: | EL-BAKRI |
Suffix: | |
Gender: | M |
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: | PO BOX 3158 |
Mailing Address - Street 2: | |
Mailing Address - City: | PORTLAND |
Mailing Address - State: | OR |
Mailing Address - Zip Code: | 97208-3158 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 503-215-6494 |
Mailing Address - Fax: | 765-741-0335 |
Practice Address - Street 1: | 18040 SW LOWER BOONES FERRY RD STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | TIGARD |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97224-7259 |
Practice Address - Country: | US |
Practice Address - Phone: | 503-216-0624 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-12-19 |
Last Update Date: | 2021-06-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OR | MD188949 | 207Q00000X, 2083X0100X |
IN | 01047189A | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2083X0100X | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 200337660 | Medicaid | |
IN | 945350065 | Medicare PIN |