Fertig, Evan Jacob

Fertig, Evan Jacob is an individual health care provider with primary practice located at 5050 Ne Hoyt St Suite 615, Portland OR 97213-2958. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Fertig, Evan Jacob can be contacted via phone (503) 215-8580.

Contact Information

Primary practice address
5050 Ne Hoyt St Suite 615 Portland OR 97213-2958
Phone: (503) 215-8580
Fax: (503) 215-8585
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 043292 Connecticut
Allopathic & Osteopathic Physicians / Neurology 2084N0400X MD173687 Oregon

Profile Details

NPI number 1275515918
LBN Legal business name Fertig, Evan Jacob
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2005
Last updated Oct 15th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275515918 NPPES
Connecticut MEDICAID 001432921
Connecticut MEDICAID 0171441
Connecticut MEDICAID 500689501

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