Individual
JEREMY FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239
(503) 494-4314
(503) 346-6810
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-4314
(503) 346-6810
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
51550
CA
363AS0400X
Surgical Physician Assistant
Primary
PA186549
OR
Other
Enumeration date
07/11/2014
Last updated
06/15/2018
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