Individual
JORDAN ISAAC ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5555 NE ELAM YOUNG PKWY, HILLSBORO, OR 97124-6452
(503) 216-1600
(503) 216-1610
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD157018
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500653994
—
OR
Enumeration date
04/13/2010
Last updated
03/24/2021
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