Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD197552 | OR |
N | 207PP0204X | Pediatric Emergency Physician | 52648 | TN |
NPI | 1023377124 |
---|---|
Provider Name | Peter Stanley Jones |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2012 |
Last Update Date | 02/07/2020 |