Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 128828 | WI |
N | 208600000X | Surgeon | 128828 | WI |
Y | 208200000X | Surgeon | MD161898 | OR |
Y | 208600000X | Surgeon | MD161898 | OR |
NPI | 1003071580 |
---|---|
Provider Name | Jordan Marie Raymer |
First Address | Portland, OR 97232-2686 |
Second Address | Florence, OR 97439-9470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2008 |
Last Update Date | 31/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2094441 | (05) | WA |
500659458 | (05) | OR |