Basic Information
Provider Information
NPI: 1700175874
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AL-HAKIM
FirstName: RAMSEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3181 SW SAM JACKSON PARK RD # L605
Address2:  
City: PORTLAND
State: OR
PostalCode: 972393011
CountryCode: US
TelephoneNumber: 5034947660
FaxNumber: 5034944258
Practice Location
Address1: 3181 SW SAM JACKSON PARK RD # L605
Address2:  
City: PORTLAND
State: OR
PostalCode: 972393011
CountryCode: US
TelephoneNumber: 5034947660
FaxNumber: 5034944258
Other Information
ProviderEnumerationDate: 03/29/2011
LastUpdateDate: 04/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202XME126654FLN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202XA123187CAN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0204XMD181942ORY Allopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology

No ID Information.


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