Individual
DR. JESSIE FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
120 NW 14TH AVE, SUITE 300, PORTLAND, OR 97209-2643
(503) 299-9906
(503) 225-9002
Mailing address
2415 SE IVON ST, PORTLAND, OR 97202-1287
(503) 922-0926
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
227596
NY
207L00000X
Anesthesiology Physician
Primary
MD27402
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274300
—
OR
05
—
8482242
—
WA
Enumeration date
01/25/2006
Last updated
02/15/2012
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