1548617483 NPI number — JEREMY ELIEZAR ADLER M.D.

Table of content: JEREMY ELIEZAR ADLER M.D. (NPI 1548617483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548617483 NPI number — JEREMY ELIEZAR ADLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADLER
Provider First Name:
JEREMY
Provider Middle Name:
ELIEZAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548617483
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
KAISER AIRPORT WAY REGIONAL LABORATORY
Provider Second Line Business Mailing Address:
13705 NE AIRPORT WAY, SUITE C
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97230-1048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
971-429-0930
Provider Business Mailing Address Fax Number:
32-586-8645

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10180 SE SUNNYSIDE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-8970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-429-0930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  MD215848 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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