Individual
JENNIFER COGBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
51377 SW OLD PORTLAND RD STE C, SCAPPOOSE, OR 97056-4023
(503) 418-4222
Mailing address
51377 SW OLD PORTLAND RD STE C, SCAPPOOSE, OR 97056-4023
(503) 418-4222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD221623
OR
207QS0010X
Sports Medicine (Family Medicine) Physician
R-12700
IA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2020
Last updated
11/04/2024
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