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Individual

JONATHAN REUEL VAN HORN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PAC

Contact information

Practice address
300 N GRAHAM ST STE 125, PORTLAND, OR 97227-1683
(503) 413-3714
(503) 413-2061
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00833
OR
363AS0400X
Surgical Physician Assistant
PA00833
OR
363AS0400X
Surgical Physician Assistant
PA10004741
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500600859
OR
Enumeration date
08/24/2005
Last updated
11/19/2019
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