Individual
JACOB HENRY NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(360) 831-3123
Mailing address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(360) 831-3123
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
DO212889
OR
207R00000X
Internal Medicine Physician
0116035953
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/05/2019
Last updated
03/13/2025
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