Individual
JACOB TRAVIS WALDRON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2043 COLLEGE WAY, FOREST GROVE, OR 97116-1797
(503) 352-2020
Mailing address
18710 MIAMI FOLEY RD, BAY CITY, OR 97107-9709
(503) 352-2020
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
OR
Other
Enumeration date
01/21/2026
Last updated
01/21/2026
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