Provider Demographics
NPI:1740351659
Name:NAJERA, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:NAJERA
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 1:18911 PORTLAND AVE
Mailing Address - Street 2:GLADSTONE COMMUNITY HEALTH CLINIC
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-1630
Mailing Address - Country:US
Mailing Address - Phone:503-850-4472
Mailing Address - Fax:503-850-4473
Practice Address - Street 1:18911 PORTLAND AVE
Practice Address - Street 2:GLADSTONE COMMUNITY HEALTH CLINIC
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-1630
Practice Address - Country:US
Practice Address - Phone:503-850-4472
Practice Address - Fax:503-850-4473
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60358207Q00000X
ORMD27297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A603580Medicaid
CA00A603580Medicaid