Provider Demographics
NPI:1588919799
Name:MATHAI, YUSUF TUMUTI (MD)
Entity type:Individual
Prefix:DR
First Name:YUSUF
Middle Name:TUMUTI
Last Name:MATHAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19365 SW 65TH AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9196
Mailing Address - Country:US
Mailing Address - Phone:503-506-8500
Mailing Address - Fax:503-506-8595
Practice Address - Street 1:19365 SW 65TH AVE STE 105
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9196
Practice Address - Country:US
Practice Address - Phone:503-506-8500
Practice Address - Fax:503-506-8595
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD174889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine