MEDICARE: DR. JERRY JEFF JABOIN 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	2085R0001X	Radiation Oncology Physician	MD174329	OR
2	2085R0001X	Radiation Oncology Physician	2010015937	MO
3	2085R0001X	Radiation Oncology Physician	38749	OK

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	431560263	OTHER	MO	TRICARE
3	P01128079	OTHER	MO	RR MCR
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578610382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY JEFF JABOIN MD

Provider Business Mailing Address
First Line	:	3181 SW SAM JACKSON PARK RD # L337
Second Line	:	DEPARTMENT OF RADIATION MEDICINE
City	:	PORTLAND
State	:	OR
Zip	:	97239-3011
Country	:	US
Telephone Number	:	503-494-8756
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 NE 10TH ST # OKCCL100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5418
Country	:	US
Telephone Number	:	405-271-5641
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	03/30/2023

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