Provider Demographics
NPI:1225123656
Name:JEWETT, STILES TURNER JR (MD)
Entity Type:Individual
Prefix:DR
First Name:STILES
Middle Name:TURNER
Last Name:JEWETT
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:12400 NW CORNELL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5616
Mailing Address - Country:US
Mailing Address - Phone:503-646-0101
Mailing Address - Fax:503-350-1420
Practice Address - Street 1:12400 NW CORNELL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5616
Practice Address - Country:US
Practice Address - Phone:503-646-0101
Practice Address - Fax:503-350-1420
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
OR11573208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC94378Medicare UPIN