Healthcare Provider Details

I. General information

NPI: 1598050825
Provider Name (Legal Business Name): JEFFREY ROBERT CAGLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 SW BARNES RD STE 150
PORTLAND OR
97225-6603
US

IV. Provider business mailing address

PO BOX 25180
PORTLAND OR
97298-0180
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-4830
  • Fax:
Mailing address:
  • Phone: 503-216-4830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1816537
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: