Basic Information
| Provider Information | |||||||||
| NPI: | 1295795938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JHOOTY | ||||||||
| FirstName: | AMEET | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15234 NW CHANNA DR | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972298719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036140667 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2801 N GANTENBEIN AVE | ||||||||
| Address2: | ROOM NO 4100 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972271623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034138407 | ||||||||
| FaxNumber: | 5034137361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2006 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD24534 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 297441 | 05 | OR | MEDICAID |