Individual
RUSSELL JARED MADSEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8211
Mailing address
6146 SW 18TH DR APT 64, PORTLAND, OR 97239-7906
(801) 310-8535
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
MD184490
OR
208D00000X
General Practice Physician
MD184490
OR
Other
Enumeration date
04/11/2012
Last updated
10/18/2019
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