Healthcare Provider Details

I. General information

NPI: 1730044587
Provider Name (Legal Business Name): JAROD CHRISTOPHER ALFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NE DIVISION ST STE 101
GRESHAM OR
97030-4617
US

IV. Provider business mailing address

4101 NE DIVISION ST STE 101
GRESHAM OR
97030-4617
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-3808
  • Fax:
Mailing address:
  • Phone: 503-666-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number115083
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: