Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD23841 | OR |
Y | 111NI0900X | Internist | MD23841 | OR |
N | 207RA0401X | Internist - Addiction Medicine | MD23841 | OR |
NPI | 1447265939 |
---|---|
Provider Name | Jessica Lampkin Gregg |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 10/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022647 | (05) | OR |
H92168 | (02) |