Omar N Qutub, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD158125 Issued in OR

Practice address

1129 NW 11TH Ave
Portland, OR 97209-3469

Phone

(503) 705-2331

NPI assigned

Jun 26, 2008

Last updated

Feb 21, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dermatology by Design LLC

  • Dermatology Physician
  • Portland, OR
  • NPI 1972004455
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519171200000",
    "number": "1124280540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 NW 11TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093469",
            "telephone_number": "503-705-2331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 NW 11TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093469",
            "telephone_number": "503-705-2331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUTUB",
        "first_name": "OMAR",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-26",
        "last_updated": "2018-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "OR",
            "license": "MD158125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Liliana Quiroz Zuniga, CMT
• Emily Anne Quist
• Krystina Alexia Quist, LMT
• Quit Falling LLC (Ingrid Borland)
• Eric D.C. Quon, PT
• R Sterling Hodgson MD LLC
• Rocky R-Robinson
• R. M. Andrews & Associates LLC
• R.E.a.P.
• Kristin Ann Rabai, DC

• Dermatology Physician in Portland, OR
• Providers in Portland, OR by specialty
• Dermatology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.