Individual
ANNA JIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
124 NE 181ST AVE, SUITE 103, PORTLAND, OR 97230-6668
(503) 489-1760
(503) 489-1763
Mailing address
124 NE 181ST AVE, SUITE 103, PORTLAND, OR 97230-6668
(503) 489-1760
(503) 489-1763
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD21969
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067463010
REGENCE
OR
01
—
911019392
COMMERCIAL
—
Enumeration date
09/06/2006
Last updated
12/13/2012
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