Individual
DR. MANISH THAKUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
9205 SW BARNES RD, PORTLAND, OR 97225-6603
(203) 415-1023
(203) 415-1023
Mailing address
PO BOX 25180, PORTLAND, OR 97298-0180
(203) 415-1023
(203) 415-0123
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
169963
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
169963
OREGON MEDICAL LICENSE DO
OR
Enumeration date
02/15/2012
Last updated
08/22/2016
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