MEDICARE: DR. JEFFREY D DISNEY MD

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	207P00000X	Emergency Medicine Physician	MD-23629	OR

General Provider Information

NPI Number	:	1306840822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY D DISNEY MD

Provider Business Mailing Address
First Line	:	1001 PROVIDENCE DR
Second Line	:	DEPT OF EMERGENCY MEDICINE
City	:	NEWBERG
State	:	OR
Zip	:	97132-7485
Country	:	US
Telephone Number	:	503-537-1785
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 PROVIDENCE DR
Second Line	:	DEPT OF EMERGENCY MEDICINE
City	:	NEWBERG
State	:	OR
Zip	:	97132-7485
Country	:	US
Telephone Number	:	503-537-1785
Fax Number	:

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/19/2008

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