Healthcare Provider Details

I. General information

NPI: 1912032707
Provider Name (Legal Business Name): JENNIFER LOUISE ZAKHIREH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LOUISE WEIK M.D.

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25050 SE STARK ST
GRESHAM OR
97030-3327
US

IV. Provider business mailing address

PO BOX 3777
PORTLAND OR
97208-3777
US

V. Phone/Fax

Practice location:
  • Phone: 503-674-1848
  • Fax:
Mailing address:
  • Phone: 503-413-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number58404
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA86308
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD218894
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: