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Individual

EVAN JACOB FERTIG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5050 NE HOYT ST, SUITE 615, PORTLAND, OR 97213-2958
(503) 215-8580
(503) 215-8585
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
043292
CT
2084N0400X
Neurology Physician
Primary
MD173687
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001432921
CT
05
0171441
NJ
05
500689501
OR
Enumeration date
11/17/2005
Last updated
10/15/2020
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