Healthcare Provider Details

I. General information

NPI: 1801177522
Provider Name (Legal Business Name): JONATHAN R EPPERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 MEDICAL CENTER PT
COLORADO SPRINGS CO
80907-5700
US

IV. Provider business mailing address

PO BOX 230457
PORTLAND OR
97281-0457
US

V. Phone/Fax

Practice location:
  • Phone: 503-906-7300
  • Fax:
Mailing address:
  • Phone: 503-906-7300
  • Fax: 503-245-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberCDRH.0065436
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number5011028925
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberDO224086
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: