Healthcare Provider Details

I. General information

NPI: 1811170905
Provider Name (Legal Business Name): JAMES BYRON CLEMENTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD, BTE 119
PORTLAND OR
97239-2997
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD, BTE 119
PORTLAND OR
97239-2997
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-6101
  • Fax: 503-494-1159
Mailing address:
  • Phone: 503-494-6101
  • Fax: 503-494-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6805114-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number6805114-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD157527
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD157527
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: