Provider Demographics
NPI:1093973000
Name:HERBER, JENNIFER DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:DAWN
Last Name:HERBER
Suffix:
Gender:F
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:PO BOX 22075
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2075
Mailing Address - Country:US
Mailing Address - Phone:503-659-4988
Mailing Address - Fax:503-659-4730
Practice Address - Street 1:3033 SE MONROE ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6636
Practice Address - Country:US
Practice Address - Phone:503-659-4988
Practice Address - Fax:503-659-4730
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR242451Medicaid
ORR142354Medicare PIN
ORR150503Medicare PIN