Individual
JENNIFER VINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
619 NW 6TH AVE FL 4, PORTLAND, OR 97209-3964
(503) 988-5020
(503) 988-5022
Mailing address
619 NW 6TH AVE FL 5, PORTLAND, OR 97209-3964
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD25769
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22959
—
OR
Enumeration date
09/29/2006
Last updated
12/12/2019
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