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NPI Code Detail

MEDICARE: JACK P SCHUNK MD

MEDICARE: JACK P SCHUNK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianMD13919OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063418325
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK P SCHUNK MD
Provider Business Mailing Address
First Line : 4307 SW IDAHO DR
Second Line :
City : PORTLAND
State : OR
Zip : 97221-3347
Country : US
Telephone Number : 503-246-9687
Fax Number :
Provider Business Practice Location Address
First Line : 2525 NW LOVEJOY ST
Second Line : STE 200
City : PORTLAND
State : OR
Zip : 97210-2863
Country : US
Telephone Number : 503-227-0671
Fax Number : 503-227-0676
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 07/08/2007

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Directions to “ JACK P SCHUNK MD” Practice Location

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