Provider Demographics
NPI:1306810023
Name:OJEABURU, JEREMIAH V (MD)
Entity type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:V
Last Name:OJEABURU
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 1:11216 SUNRISE BLVD E STE 3-207
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-8848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11216 SUNRISE BLVD E STE 3-207
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8848
Practice Address - Country:US
Practice Address - Phone:253-272-8148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041002207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8327157Medicaid
WAMD00041002OtherWA LICENSE
WAMD00041002OtherWA LICENSE
WA000188100Medicare PIN
WA110238808Medicare PIN
WA8327157Medicaid
WAG8851594Medicare PIN
WA8851594Medicare PIN
WAAB32048Medicare PIN
WAG8851595Medicare PIN
WAG8851597Medicare PIN
WA001045700Medicare PIN
WAAB32675Medicare PIN