Provider Demographics
NPI:1174532485
Name:YAKIMOVSKY, YORAM (MD)
Entity type:Individual
Prefix:DR
First Name:YORAM
Middle Name:
Last Name:YAKIMOVSKY
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 1:17860 ROBIN VIEW CT
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1055
Mailing Address - Country:US
Mailing Address - Phone:503-954-6074
Mailing Address - Fax:
Practice Address - Street 1:17860 ROBIN VIEW CT
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1055
Practice Address - Country:US
Practice Address - Phone:503-954-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD12635207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226654Medicaid
AKMD8142RMedicaid
OR050000426OtherRR MEDICARE
WA1768704Medicaid
MD4160444 00Medicaid
MD4160444 00Medicaid
OR226654Medicaid