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General NPI Number Information
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NPI Number | 1295354140
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Entity Type | Individual
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Provider Name | JENNIFER COGBURN MD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 51377 SW OLD PORTLAND RD STE C
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City | SCAPPOOSE
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State | OR
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Zip | 97056-4023
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Country | US
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Telephone | 503-418-4222
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Fax |
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Provider Business Mailing Address
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Address Line | 51377 SW OLD PORTLAND RD STE C
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City | SCAPPOOSE
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State | OR
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Zip | 97056-4023
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Country | US
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Telephone | 503-418-4222
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | R-12700
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD221623
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License Number State | OR
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