Healthcare Provider Details

I. General information

NPI: 1306840822
Provider Name (Legal Business Name): JEFFREY D DISNEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PROVIDENCE DR DEPT OF EMERGENCY MEDICINE
NEWBERG OR
97132-7485
US

IV. Provider business mailing address

1001 PROVIDENCE DR DEPT OF EMERGENCY MEDICINE
NEWBERG OR
97132-7485
US

V. Phone/Fax

Practice location:
  • Phone: 503-537-1785
  • Fax:
Mailing address:
  • Phone: 503-537-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD-23629
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: