Provider Demographics
NPI:1306304951
Name:ABDI, JEMAL BELDA
Entity type:Individual
Prefix:MR
First Name:JEMAL
Middle Name:BELDA
Last Name:ABDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 SE 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1508
Mailing Address - Country:US
Mailing Address - Phone:503-358-7485
Mailing Address - Fax:
Practice Address - Street 1:2624 SE 85TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1508
Practice Address - Country:US
Practice Address - Phone:503-358-7485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-02
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9787594172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty