Individual
EMONIEL ISAKHAROV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19875 SW 65TH AVE STE 100, TUALATIN, OR 97062-8353
(503) 692-7785
Mailing address
PO BOX 6689, PORTLAND, OR 97228-6689
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD204965
OR
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/13/2018
Last updated
07/27/2021
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