Individual
MR. THOMAS ANDREW VANDERJAGT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PH.D
Contact information
Practice address
233 NE 102ND AVE, PORTLAND, OR 97220-4106
(503) 253-1105
Mailing address
233 NE 102ND AVE, PORTLAND, OR 97220-4106
(503) 253-1105
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD186415
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/21/2015
Last updated
06/15/2021
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