Healthcare Provider Details

I. General information

NPI: 1841201894
Provider Name (Legal Business Name): JANE E BEDELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NW BETHANY BLVD STE 100
BEAVERTON OR
97006-5208
US

IV. Provider business mailing address

PO BOX 23200
PORTLAND OR
97281-3200
US

V. Phone/Fax

Practice location:
  • Phone: 503-619-1100
  • Fax: 503-619-1101
Mailing address:
  • Phone: 503-619-1100
  • Fax: 503-619-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD13166
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: