DR. BOBAK AMIR GHAHERI (NPI# 1114098696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114098696 |
| Entity Type | Individual |
| Full Name | DR. BOBAK AMIR GHAHERI |
| Other Name | DR. BOBBY AMIR GHAHERI |
| Credential | M.D. |
| Practice Address |
24076 Se Stark St Suite 230 Gresham OR 97030-3373 |
| Mailing Address |
847 Ne 19th Ave Suite 300 Portland OR 97232-2684 |
| Practice Telephone | 5034882600 |
| Practice Fax Number | 5034655468 |
| Mailing Telephone | 5039632801 |
| Mailing Fax Number | 5039632825 |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2013-09-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | MD27404 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 006246 | 05 | |
| WA | 8481699 | 05 |
| Street Address |
24076 SE STARK ST SUITE 230 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-3373 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720070873 | Shammai Rockove | Urology | 24076 Se Stark St, Suite 310, Gresham, OR 97030-3373 | 2005-08-16 |
| 1538659578 | Claire Valentine | Physical Therapist | 24076 Se Stark St, Gresham, OR 97030 | 2018-05-15 |
| 1598289282 | Stephen Matthew Block | Physical Therapist | 24076 Se Stark St, Gresham, OR 97030-3373 | 2017-08-03 |
| 1114479458 | Anna Lee | Physician Assistant | 24076 Se Stark St, Suite 230, Gresham, OR 97030-3373 | 2016-11-03 |
| 1265801070 | Patrick Clinton | Physical Therapist | 24076 Se Stark St, Suite 200, Gresham, OR 97030-3373 | 2015-09-22 |
| 1932548161 | Jenna Lee Esterberg | Physician Assistant | 24076 Se Stark St, Suite 230, Gresham, OR 97030-3373 | 2013-06-20 |
| 1922371947 | Armworks Hand Therapy, LLC | Durable Medical Equipment & Medical Supplies | 24076 Se Stark St, Suite 200, Gresham, OR 97030-3373 | 2012-02-22 |
| 1225311210 | Shelley Piers-vanderploeg | Physical Therapist | 24076 Se Stark St, Suite 200, Gresham, OR 97030-3373 | 2011-09-26 |
| 1932497518 | Christina Doughty | Physician Assistant | 24076 Se Stark St, Suite 110, Gresham, OR 97030-3373 | 2011-07-15 |
| 1205130473 | Jennifer Robyn Briggs | Audiologist | 24076 Se Stark St, Suite 230, Gresham, OR 97030-3373 | 2011-01-03 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811164262 | Carrie Maiorana Brown | Otolaryngology | 24076 Se Stark St Ste 230, Gresham, OR 97030 | 2008-05-14 |
| 1720028335 | Christy Richter Buckman | Otolaryngology | 24076 Se Stark St, Suite 230, Gresham, OR 97030-3373 | 2006-06-08 |
| 1265407019 | Roya Mansouri | Otolaryngology | 24076 Se Stark St, Suite 230, Gresham, OR 97030-3373 | 2006-02-22 |
| 1649245499 | Roger John Wobig | Otolaryngology | 24076 Se Stark St, Suite 230, Gresham, OR 97030-3373 | 2006-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
| 1104289933 | Ci An Gerald Tay | Otolaryngology | 3181 Sw Sam Jackson Park Rd, Pv01, Portland, OR 97239 | 2016-03-30 |
| 1922471291 | Caitlin Bertelsen | Otolaryngology | 3303 Sw Bond Ave Ste 15, Portland, OR 97239-4501 | 2015-11-08 |
| 1326467812 | Tyler Scott Weaver | Otolaryngology | 1508 Division St Ste 115, Oregon City, OR 97045-1584 | 2014-04-10 |
| 1013286822 | Lawrence Thomas Eschelman | Otolaryngology | 3585 Cherokee Dr S, Salem, OR 97302-9712 | 2011-12-22 |
| 1962708578 | John A Lindgren, Md PC | Otolaryngology | 9155 Sw Barnes Rd Ste 401, Portland, OR 97225-6631 | 2011-01-28 |
| 1558674861 | Lucas Rein Rudmik | Otolaryngology | 3720 Sw Bond Ave Unit 2210, Portland, OR 97239-4577 | 2010-07-16 |
| 1134447741 | Aleen J Lee | Otolaryngology | 9280 Se Sunnybrook Blvd Ste 300, Clackamas, OR 97015 | 2010-05-06 |
| 1114193448 | Ryan Jeffrey Li | Otolaryngology | 3181 Sw Sam Jackson Park Rd # 01, Portland, OR 97239-3011 | 2008-05-06 |
| 1609062249 | Kenneth Albert Springate | Otolaryngology | 2095 Broadview St, Eugene, OR 97405-1375 | 2007-09-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.