Individual
PETER MICHAEL DEJONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16770 SW EDY RD STE 102, SHERWOOD, OR 97140-9679
(503) 216-9600
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD212000
OR
2083S0010X
Sports Medicine (Preventive Medicine) Physician
MD212000
OR
Other
Enumeration date
04/02/2018
Last updated
11/10/2022
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