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1912963299

NPI Code Detail

MEDICARE: DR. LYLE L JOBE MD

MEDICARE: DR. LYLE L JOBE 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
1	2084P0804X	Child & Adolescent Psychiatry Physician	MD164491	OR
2	2084P0800X	Psychiatry Physician	MD164491	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	50023461	OTHER	PA	CAPITAL BLUE CROSS
3	802092	OTHER	PA	HIGHMARK BS

General Provider Information

NPI Number	:	1912963299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYLE L JOBE MD

Provider Business Mailing Address
First Line	:	17742 MARYLCREEK DR
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97034-4017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 NE GRAND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2968
Country	:	US
Telephone Number	:	503-232-1099
Fax Number	:	503-232-3669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	04/21/2014

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Directions to “ DR. LYLE L JOBE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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