Individual
DR. PRASHANTH NMI VALLABHANATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1955 NW NORTHRUP ST, PORTLAND, OR 97209-1614
(503) 227-2020
(503) 222-0614
Mailing address
PO BOX 22009, PORTLAND, OR 97269-2009
(503) 558-7372
(503) 344-5140
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
MD22584
OR
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
MD22584
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288426
—
OR
Enumeration date
11/16/2005
Last updated
02/20/2021
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