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Individual

JENNIFER M. GIBSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3449 N ANCHOR ST STE 300A, PORTLAND, OR 97217-7679
(503) 283-0013
(503) 283-0785
Mailing address
3449 N ANCHOR ST STE 300A, PORTLAND, OR 97217-7679
(503) 283-0013
(503) 283-0785

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
37913
IA
208VP0000X
Pain Medicine Physician
37913
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1144299900
MN MEDICAID
IA
05
1144299900
IA
Enumeration date
03/15/2006
Last updated
03/27/2013
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