Basic Information
| Provider Information | |||||||||
| NPI: | 1386672475 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAMASE | ||||||||
| FirstName: | MELVIN | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 CENTERPOINTE DRIVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037972250 | ||||||||
| FaxNumber: | 5039140335 | ||||||||
| Practice Location | |||||||||
| Address1: | 1185 S ELM STREET | ||||||||
| Address2: | |||||||||
| City: | CANBY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037234660 | ||||||||
| FaxNumber: | 5032666649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 07/15/2014 | ||||||||
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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 | 207R00000X | MD15185 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 009998 | 05 | OR | MEDICAID |