Basic Information
| Provider Information | |||||||||
| NPI: | 1306041637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YEFREMOVA | ||||||||
| FirstName: | TATYANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11046 SW GREENBURG RD APT 231 | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972235438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036206428 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2800 N VANCOUVER AVE | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972271630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034132901 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | LL16477 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.