Provider Demographics
NPI:1861811564
Name:DAVIS, JEFFREY DORLAND (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DORLAND
Last Name:DAVIS
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 1:3181 SW SAM JACKSON PARK RD # UH2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3098
Mailing Address - Country:US
Mailing Address - Phone:503-494-7641
Mailing Address - Fax:503-494-4661
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD # L-579
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3098
Practice Address - Country:US
Practice Address - Phone:503-494-8652
Practice Address - Fax:503-494-8513
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD182844207LC0200X, 207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology