Individual
BARRY A JACOSHENK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1515 NW 18TH AVE, SUITE 300, PORTLAND, OR 97209-2516
(503) 224-8399
(503) 224-5661
Mailing address
1515 NW 18TH AVE, SUITE 300, PORTLAND, OR 97209-2516
(503) 224-8399
(503) 224-5661
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA00938
OR
Other
Enumeration date
01/02/2007
Last updated
07/08/2007
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