Individual
EDEM NYONATOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10123 SE MARKET ST, PORTLAND, OR 97216-2532
(503) 257-2500
Mailing address
PO BOX 92900, PORTLAND, OR 97292-0900
(503) 257-2500
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD26162
OR
208M00000X
Hospitalist Physician
Primary
MD26162
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026826
—
OR
01
—
838334011
BCBS-ROSEBURG
OR
01
—
858463010
BCBS-MEDFORD
OR
01
—
858464008
BCBS-SPRINGFIELD
OR
01
—
P00276736
RR MEDICARE
OR
Enumeration date
03/28/2006
Last updated
03/17/2018
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