Individual
JEANA LYN SUMMERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 214-5200
(503) 906-6613
Mailing address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 214-5200
(503) 906-6613
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
DO193479
OR
207Q00000X
Family Medicine Physician
DO193479
OR
207X00000X
Orthopaedic Surgery Physician
Primary
DO193479
OR
207XP3100X
Pediatric Orthopaedic Surgery Physician
DO193479
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5800764870
—
OR
01
—
DO193479
OREGON MEDICAL LICENSE
OR
Enumeration date
05/22/2013
Last updated
08/27/2024
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