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Individual

DR. JENNI CONNER DELEON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4579
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4579

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD25369
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
022756
OR
01
1407812365
NBMC NPI NUMBER-GROUP
OR
01
930635514
GROUP TAX ID
OR
01
R0000WFBTV
MEDICARE GROUP PIN
OR
Enumeration date
12/05/2005
Last updated
05/20/2013
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