Individual
JACOB P CASEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4805 NE GLISAN ST STE BG05, PORTLAND, OR 97213
(503) 215-2392
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD189221
OR
Other
Enumeration date
05/22/2015
Last updated
02/18/2021
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