MEDICARE: DR. STILES TURNER JEWETT JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	11573	OR

General Provider Information

NPI Number	:	1225123656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STILES TURNER JEWETT JR. M.D.

Provider Business Mailing Address
First Line	:	12400 NW CORNELL RD
Second Line	:	SUITE 200
City	:	PORTLAND
State	:	OR
Zip	:	97229-5616
Country	:	US
Telephone Number	:	503-646-0101
Fax Number	:	503-350-1420

Provider Business Practice Location Address
First Line	:	12400 NW CORNELL RD
Second Line	:	SUITE 200
City	:	PORTLAND
State	:	OR
Zip	:	97229-5616
Country	:	US
Telephone Number	:	503-646-0101
Fax Number	:	503-350-1420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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