Basic Information
| Provider Information | |||||||||
| NPI: | 1588635437 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAMZY | ||||||||
| FirstName: | AMEEN | ||||||||
| MiddleName: | ISHAK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 N GRAHAM | ||||||||
| Address2: | SUITE 580 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035280704 | ||||||||
| FaxNumber: | 5035280708 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 N GRAHAM | ||||||||
| Address2: | SUITE 580 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035280704 | ||||||||
| FaxNumber: | 5035280708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD22704 | OR | X | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 13134 | NE | X | Allopathic & Osteopathic Physicians | Surgery | 208600000X | D25182 | MD | X | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | MD22704 | OR | X | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 227888 | 05 | OR | MEDICAID |