Individual
JACOB ABRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9427 SW BARNES ROAD, SUITE 498, PORTLAND, OR 97225-6652
(503) 216-0900
(503) 216-0950
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD29208
OR
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
MD29208
OR
207RC0000X
Cardiovascular Disease Physician
MD0048397
WA
207RC0000X
Cardiovascular Disease Physician
MD29208
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500609590
—
OR
01
—
P00873816
RR MEDICARE
OR
01
—
P00991145
RR MEDICARE
WA
Enumeration date
04/11/2006
Last updated
10/02/2020
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