Individual
JASON ROLAND WOLLMUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1111 NE 99TH AVE STE 201, PORTLAND, OR 97220-9442
(503) 962-1000
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD26636
OR
207RI0011X
Interventional Cardiology Physician
Primary
MD26636
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240371
—
OR
Enumeration date
02/27/2006
Last updated
10/06/2020
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