Individual
MR. MESERET MEHRETAB ASFEHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3327 SE 127TH PL, PORTLAND, OR 97236-3218
(503) 502-5048
Mailing address
3327 SE 127TH PL, PORTLAND, OR 97236-3218
(503) 502-5048
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
4368954
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47-1107956
—
OR
Enumeration date
04/16/2021
Last updated
04/16/2021
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