Individual
DR. JEREMY KAYNE OTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 652-2880
Mailing address
2920 SW 55TH DR, PORTLAND, OR 97221-2215
(503) 297-5062
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD13023
OR
Other
Enumeration date
09/02/2006
Last updated
02/04/2022
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