Provider Demographics
NPI:1043475528
Name:LIN, JENNIFER E (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-538-2698
Mailing Address - Fax:503-554-9328
Practice Address - Street 1:1003 PROVIDENCE DR
Practice Address - Street 2:SUITE 340
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-7521
Practice Address - Country:US
Practice Address - Phone:503-538-2698
Practice Address - Fax:503-554-9328
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD156662207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR165510OtherMEDICARE PTAN (NON YAMHILL COUNTY)
OR500645270Medicaid
ORR184406OtherMEDICARE PTAN YAMHILL COUNTY