Healthcare Provider Details

I. General information

NPI: 1104070168
Provider Name (Legal Business Name): JUNIPER MARTIN N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11845 SW GREENBURG RD STE 110
TIGARD OR
97223-6464
US

IV. Provider business mailing address

11845 SW GREENBURG RD STE 110
TIGARD OR
97223-6464
US

V. Phone/Fax

Practice location:
  • Phone: 971-328-0071
  • Fax: 503-443-2142
Mailing address:
  • Phone: 971-328-0071
  • Fax: 503-443-2142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number1621
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1621
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1621
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1621
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: