Provider Demographics
NPI:1114193836
Name:EDMINSTER, JILL C (DO)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:C
Last Name:EDMINSTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2282 NW NORTHRUP ST
Mailing Address - Street 2:LEGACY MEDICAL GROUP
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2919
Mailing Address - Country:US
Mailing Address - Phone:503-276-8885
Mailing Address - Fax:
Practice Address - Street 1:2282 NW NORTHRUP ST
Practice Address - Street 2:LEGACY MEDICAL GROUP
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2919
Practice Address - Country:US
Practice Address - Phone:503-276-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO153185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine