Healthcare Provider Details

I. General information

NPI: 1174597165
Provider Name (Legal Business Name): JENNIFER LYNN MASSARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN ROCK M.D.

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 ELM ST SW SUITE 200
ALBANY OR
97321
US

IV. Provider business mailing address

705 ELM ST SW STE 200
ALBANY OR
97321-1957
US

V. Phone/Fax

Practice location:
  • Phone: 541-812-4850
  • Fax: 541-812-4889
Mailing address:
  • Phone: 541-812-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD151178
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD61120008
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35721
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: