Healthcare Provider Details

I. General information

NPI: 1427278399
Provider Name (Legal Business Name): JENNIFER ROSE GARREAU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 07/08/2007
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

10298 NW FOREST VIEW WAY
PORTLAND OR
97229-5288
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-9000
  • Fax:
Mailing address:
  • Phone: 503-297-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL16401
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: