Healthcare Provider Details

I. General information

NPI: 1134235930
Provider Name (Legal Business Name): JASON G ANDERSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 SW BORLAND RD STE A2
TUALATIN OR
97062-8854
US

IV. Provider business mailing address

6464 SW BORLAND RD STE A2
TUALATIN OR
97062-8854
US

V. Phone/Fax

Practice location:
  • Phone: 503-885-1515
  • Fax: 503-885-1520
Mailing address:
  • Phone: 503-885-1515
  • Fax: 503-885-1520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDO150752
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: