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Individual

JONATHAN D FISK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1000 N PROVIDENCE DR STE 120, NEWBERG, OR 97132-7582
(503) 537-5900
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA210939
OR
363AS0400X
Surgical Physician Assistant
C0006675
MD

Other

Enumeration date
01/17/2018
Last updated
02/09/2023
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