Individual
PUNAG DIVANJI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7400
(503) 494-4749
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7400
(503) 494-4749
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD193114
OR
207RC0000X
Cardiovascular Disease Physician
Primary
MD193114
OR
207RI0011X
Interventional Cardiology Physician
MD193114
OR
Other
Enumeration date
04/14/2011
Last updated
09/04/2019
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