Individual
JAY S. ROSENBLOOM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2525 NW LOVEJOY ST, STE 200, PORTLAND, OR 97210-2863
(503) 227-0671
(503) 227-0676
Mailing address
11516 SW VACUNA CT, PORTLAND, OR 97219-8901
(503) 244-3344
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD21098
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134246
—
OR
Enumeration date
06/22/2005
Last updated
07/08/2007
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