Provider Demographics
NPI:1326851916
Name:MELES, EYOB BRHANE
Entity type:Individual
Prefix:
First Name:EYOB
Middle Name:BRHANE
Last Name:MELES
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 1:23 N WYGANT ST APT B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2863
Mailing Address - Country:US
Mailing Address - Phone:206-383-2885
Mailing Address - Fax:
Practice Address - Street 1:23 N WYGANT ST APT B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2863
Practice Address - Country:US
Practice Address - Phone:206-383-2885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)