Provider Demographics
NPI:1033223656
Name:CHOWDHURY, MUSTAQUIM FARUQ (MD)
Entity type:Individual
Prefix:
First Name:MUSTAQUIM
Middle Name:FARUQ
Last Name:CHOWDHURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 SE 8TH AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4250
Mailing Address - Country:US
Mailing Address - Phone:503-681-4233
Mailing Address - Fax:503-681-4234
Practice Address - Street 1:364 SE 8TH AVE STE 301
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4250
Practice Address - Country:US
Practice Address - Phone:503-681-4233
Practice Address - Fax:503-681-4234
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 22412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288211Medicaid
ORMD22412OtherSTATE MEDICAL LICENSE
207R00000XOtherINTERNAL MEDICINE TAXONOM
OR288211Medicaid
107165Medicare PIN