MEDICARE: JAY C. P. JAN 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	208600000X	Surgery Physician	MD24533	OR
2	208600000X	Surgery Physician	MD00047700	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417949926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY C. P. JAN MD

Provider Business Mailing Address
First Line	:	1130 NW 22ND AVE
Second Line	:	SUITE 500
City	:	PORTLAND
State	:	OR
Zip	:	97210-2900
Country	:	US
Telephone Number	:	503-413-5725
Fax Number	:	503-413-5726

Provider Business Practice Location Address
First Line	:	1130 NW 22ND AVE
Second Line	:	SUITE 500
City	:	PORTLAND
State	:	OR
Zip	:	97210-2900
Country	:	US
Telephone Number	:	503-413-5725
Fax Number	:	503-413-5726

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	03/19/2013

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Directions to “ JAY C. P. JAN MD” Practice Location

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