NPI 1336157882 · live from the CMS NPI Registry
Jon Michael Hanifin, MD
Dermatology in Portland, OR. National Provider Identifier 1336157882, active.
NPI record
| NPI | 1336157882 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dermatology 207N00000X |
| Practice location | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239 |
| Practice phone | 503-418-3376 |
| Mailing address | 4108 Sw Greenleaf Ct, Portland, OR 97221 |
| Enumerated | August 3, 2006 |
| Last updated | July 8, 2007 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology primary | 207N00000X | MD08045 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.