Provider Demographics
NPI:1043426349
Name:BRILL, JANAE Z (MD)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:Z
Last Name:BRILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANAE
Other - Middle Name:D
Other - Last Name:ZOLNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:345 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3610
Mailing Address - Country:US
Mailing Address - Phone:503-266-2066
Mailing Address - Fax:503-263-8719
Practice Address - Street 1:345 N GRANT ST
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3610
Practice Address - Country:US
Practice Address - Phone:503-266-2066
Practice Address - Fax:503-263-8719
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110101207Q00000X
ORMD163282207Q00000X
WAMD61199795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500660077Medicaid