Provider Demographics
NPI:1437449287
Name:VEMBU MOERKERKE, TREVOR J (MD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:J
Last Name:VEMBU MOERKERKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TREVOR
Other - Middle Name:J
Other - Last Name:MOERKERKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:7305 SE CIRCUIT DR STE 180
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-1915
Practice Address - Country:US
Practice Address - Phone:971-501-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD165926207Q00000X
OR165926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare PIN