Provider Demographics
NPI:1003891524
Name:JANSSEN, ANDREW G (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:G
Last Name:JANSSEN
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 1:7529 SE TUALATIN VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-8252
Mailing Address - Country:US
Mailing Address - Phone:503-681-4240
Mailing Address - Fax:503-681-4241
Practice Address - Street 1:7529 SE TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-8252
Practice Address - Country:US
Practice Address - Phone:503-681-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132391Medicare ID - Type Unspecified
I31126Medicare UPIN