Healthcare Provider Details

I. General information

NPI: 1336154855
Provider Name (Legal Business Name): TIMOTHY JAY JEFFREYS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 DIVISION ST STE 280
OREGON CITY OR
97045-2550
US

IV. Provider business mailing address

1510 DIVISION ST STE 280
OREGON CITY OR
97045-2550
US

V. Phone/Fax

Practice location:
  • Phone: 503-905-3400
  • Fax:
Mailing address:
  • Phone: 503-905-3400
  • Fax: 503-905-3399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD15623
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier008321
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: