Healthcare Provider Details

I. General information

NPI: 1699877258
Provider Name (Legal Business Name): JEANNE MOWRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 02/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 N INTERSTATE AVE
PORTLAND OR
97227-1196
US

IV. Provider business mailing address

3550 N INTERSTATE AVE KAISER PERMANENTE INTERSTATE MEDICAL OFFICE EAST
PORTLAND OR
97227-1196
US

V. Phone/Fax

Practice location:
  • Phone: 503-331-6440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD00038073
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD18994
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: