Healthcare Provider Details

I. General information

NPI: 1215182035
Provider Name (Legal Business Name): JAMIE O LO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD # L466 DEPARTMENT OF OBSTETRICS AND GYNECOLOGY - OFFICE SJH 23
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD # L466
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 503-679-2025
  • Fax:
Mailing address:
  • Phone: 503-679-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60471447
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD157181
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number74714991205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: