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General NPI Number Information
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NPI Number | 1578712519
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Entity Type | Individual
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Provider Name | JIMMIE NICK TARRO MD
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Gender | Male
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 5331 SW MACADAM AVE STE 307
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City | PORTLAND
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State | OR
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Zip | 97239-3859
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Country | US
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Telephone | 503-294-7193
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Fax | 503-294-0231
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Provider Business Mailing Address
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Address Line | 5486 SW NATCHEZ ST
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City | TUALATIN
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State | OR
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Zip | 97062-9766
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Country | US
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Telephone | 503-692-0918
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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 | 208U00000X
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Taxonomy Name | Clinical Pharmacology Physician
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License Number | MDO7596
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License Number State | OR
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