Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 4301087739 | MI |
N | 207ND0900X | Dermatopathologist | 4301087739 | MI |
NPI | 1003940966 |
---|---|
Provider Name | Dr. Jessica Marie Ghaferi |
First Address | Tigard, OR 97281-0457 |
Second Address | Tigard, OR 97223-8246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 12/10/2020 |