Provider Demographics
NPI:1144292152
Name:NYE, JERRY E (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:E
Last Name:NYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 NW LOVEJOY
Mailing Address - Street 2:STE 401
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-274-4865
Mailing Address - Fax:503-274-4989
Practice Address - Street 1:2222 NW LOVEJOY
Practice Address - Street 2:STE 401
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-274-4865
Practice Address - Fax:503-274-4989
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD07807207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C93423Medicare UPIN
0000BHCDSMedicare ID - Type Unspecified