Individual
AJITKUMAR N JETMALANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-6176
(503) 494-6152
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-6176
(503) 494-6152
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
MD15652
OR
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
MD15652
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Z10716
—
OR
Enumeration date
12/01/2006
Last updated
12/11/2018
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