Healthcare Provider Details

I. General information

NPI: 1023424256
Provider Name (Legal Business Name): JEFFREY C DART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 8TH AVE STE 100
WEST LINN OR
97068-4657
US

IV. Provider business mailing address

PO BOX 22075
MILWAUKIE OR
97269-2075
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-4988
  • Fax: 833-428-4938
Mailing address:
  • Phone: 503-659-4988
  • Fax: 833-428-4938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD188398
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD188398
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: