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1730171117

NPI Code Detail

MEDICARE: JEANNIE LOUIE MD

MEDICARE: JEANNIE LOUIE 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	MD22295	OR

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730171117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNIE LOUIE MD

Provider Business Mailing Address
First Line	:	541 NE 20TH AVE STE 225
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-2895
Country	:	US
Telephone Number	:	503-963-2801
Fax Number	:	503-963-2825

Provider Business Practice Location Address
First Line	:	9205 SW BARNES RD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-6603
Country	:	US
Telephone Number	:	503-216-2195
Fax Number	:	503-216-2196

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	12/05/2023

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Directions to “ JEANNIE LOUIE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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