Active NPI
Maya Gillam, L.M.T.
- Specialist
- Beaverton, OR
National Provider Identifier
1811226665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 14240
- Practice address
- 12555 SW 1St St
Beaverton, OR 97005 - Phone
- (503) 619-6936
- NPI assigned
- Dec 8, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 14240 | OR | Primary |
Addresses
Primary practice location
12555 SW 1St St
Beaverton, OR 97005
Mailing address
12555 SW First St
Beaverton, OR 97005
Phone (503) 619-6936
Other names 1
- Mrs. Maya Yurevich
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14240 | OR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260230400000",
"number": "1811226665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12555 SW FIRST ST",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "97005",
"telephone_number": "503-619-6936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12555 SW 1ST ST",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "97005",
"telephone_number": "503-619-6936"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLAM",
"first_name": "MAYA",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-12-08",
"last_updated": "2009-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "14240",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MAYA",
"last_name": "YUREVICH",
"prefix": "MRS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.