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General NPI Number Information
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NPI Number | 1023103652
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Entity Type | Individual
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Provider Name | JACOB ANDERSON REISS M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 3325 N INTERSTATE AVE
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City | PORTLAND
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State | OR
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Zip | 97227-1022
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Country | US
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Telephone | 503-331-6596
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Fax | 503-331-6320
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Provider Business Mailing Address
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Address Line | 3325 N INTERSTATE AVE KAISER PERMANENTE INTERSTATE MEDICAL OFFICE WEST
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City | PORTLAND
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State | OR
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Zip | 97227-1020
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Country | US
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Telephone | 503-813-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | OR MD08690
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | WA MD00013839
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | G21401
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License Number State | CA
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