Individual
DERRICK MICHAEL JONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
12710 SE DIVISION ST, PORTLAND, OR 97236-3134
(503) 988-3601
Mailing address
9701 SE JOHNSON CREEK BLVD APT B208, HAPPY VALLEY, OR 97086-3671
(918) 859-7819
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA196333
OR
Other
Enumeration date
01/15/2020
Last updated
01/15/2020
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