Provider Demographics
NPI:1871535625
Name:AKPAMGBO, JANE-FRANCES IFEOMA (MD)
Entity type:Individual
Prefix:
First Name:JANE-FRANCES
Middle Name:IFEOMA
Last Name:AKPAMGBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANE-FRANCES
Other - Middle Name:IFEOMA
Other - Last Name:NWOSU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8100
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97303-0900
Mailing Address - Country:US
Mailing Address - Phone:503-399-2424
Mailing Address - Fax:503-375-7429
Practice Address - Street 1:1165 UNION ST NE
Practice Address - Street 2:SUITE 200
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4693
Practice Address - Country:US
Practice Address - Phone:503-399-2424
Practice Address - Fax:503-375-7429
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042028207Q00000X
ORMD156962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500646479Medicaid
ORR165524Medicare PIN
WA8856591Medicare PIN
WAH94036Medicare UPIN
OR1228590003Medicare NSC