Healthcare Provider Details

I. General information

NPI: 1215256391
Provider Name (Legal Business Name): LESLIE JAY STARKEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAY STARKEY M.D.

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-0990
  • Fax: 503-494-4982
Mailing address:
  • Phone: 503-418-0990
  • Fax: 503-494-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD187466
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD187466
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: