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Individual

JEANENE ANN SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3930 SE DIVISION ST, PORTLAND, OR 97202-1643
(503) 418-3900
Mailing address
9060 SW SUNSTEAD LN, PORTLAND, OR 97225-2555

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD15518
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
078683
OR
Enumeration date
08/03/2006
Last updated
07/08/2007
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