Individual
JESSICA DALE MACDOUGALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-4300
(503) 494-4323
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-4300
(503) 494-4323
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
MD216054
OR
390200000X
Student in an Organized Health Care Education/Training Program
238201
NC
Other
Enumeration date
05/07/2018
Last updated
09/13/2023
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