Individual
DR. JEFFREY DAVID MUDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5050 NE HOYT ST STE 522, PORTLAND, OR 97213
(503) 236-4343
(503) 234-0271
Mailing address
5050 NE HOYT ST STE 522, PORTLAND, OR 97213-2984
(503) 236-4343
(503) 234-0271
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD163714
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11984603
CAQH
—
Enumeration date
03/31/2007
Last updated
09/26/2023
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