Individual
MICHAEL P. JACZKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1000 N PROVIDENCE DR STE 210, NEWBERG, OR 97132-7582
(503) 537-5900
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO20026
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
151081
—
OR
Enumeration date
08/30/2005
Last updated
03/18/2021
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