MEDICARE: JAY PAUL DOUGLASS MD LLC

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	207R00000X	Internal Medicine Physician	MD153785	OR

General Provider Information

NPI Number	:	1578849360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY PAUL DOUGLASS MD LLC

Provider Business Mailing Address
First Line	:	6464 SW BORLAND RD STE C1
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-8856
Country	:	US
Telephone Number	:	503-635-6256
Fax Number	:	503-636-9604

Provider Business Practice Location Address
First Line	:	6464 SW BORLAND RD STE C1
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-8856
Country	:	US
Telephone Number	:	503-635-6256
Fax Number	:	503-636-9604

Authorized Official
Title or Position	:	MEMBER
Name	:	JAY PAUL DOUGLASS
Credential	:	MD
Telephone Number	:	503-635-6256

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	07/15/2024

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