Healthcare Provider Details

I. General information

NPI: 1427002187
Provider Name (Legal Business Name): JEANNE H BUTTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNE BUTTON M.D.

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 NW 22ND AVE SUITE 320
PORTLAND OR
97210-3057
US

IV. Provider business mailing address

PO BOX 3808
PORTLAND OR
97208-3808
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-6294
  • Fax: 503-413-7780
Mailing address:
  • Phone: 503-413-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD28103
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD28103
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberM3945
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: