Individual
JESSICA N MEHTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
18040 SW LOWER BOONES FERRY RD, SUITE 100, TIGARD, OR 97224-7258
(503) 216-0770
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD26617
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028278
—
OR
01
—
P00443453
RR MEDICARE
OR
01
—
P00468706
RR MEDICARE
OR
Enumeration date
06/06/2006
Last updated
10/20/2020
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