Individual
JENNIFER TOBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7641
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7641
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA10004894
WA
363AM0700X
Medical Physician Assistant
Primary
PA165082
OR
363AS0400X
Surgical Physician Assistant
PA165082
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500664202
—
OR
Enumeration date
10/17/2006
Last updated
12/22/2020
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