Healthcare Provider Details

I. General information

NPI: 1336889476
Provider Name (Legal Business Name): JORDAN MARIE MATTERN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 COUNTRY CLUB PKWY STE B
EUGENE OR
97401-6038
US

IV. Provider business mailing address

PO BOX 70368
SPRINGFIELD OR
97475-0120
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-2922
  • Fax: 541-683-1709
Mailing address:
  • Phone: 541-485-2777
  • Fax: 541-246-2353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD229163
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: