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NPI Code Detail

MEDICARE: JARED PAUL MARTIN NP

MEDICARE: JARED PAUL MARTIN NP
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
1363LF0000XFamily Nurse Practitioner201400663NP-PPOR

General Provider Information

NPI Number : 1336485259
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARED PAUL MARTIN NP
Provider Business Mailing Address
First Line : 4550 KRUSE WAY STE 125
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-3533
Country : US
Telephone Number : 503-457-7295
Fax Number : 855-861-6377
Provider Business Practice Location Address
First Line : 4550 KRUSE WAY STE 125
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-3533
Country : US
Telephone Number : 503-457-7295
Fax Number : 503-457-7295
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2012
Last Update Date : 06/23/2025

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