Provider Demographics
NPI:1295398691
Name:ALBRICH, JORDAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ROBERT
Last Name:ALBRICH
Suffix:
Gender:M
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 790
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-0790
Mailing Address - Country:US
Mailing Address - Phone:503-302-0967
Mailing Address - Fax:
Practice Address - Street 1:3240 NE 3RD AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2408
Practice Address - Country:US
Practice Address - Phone:360-729-8234
Practice Address - Fax:360-729-3337
Is Sole Proprietor?:No
Enumeration Date:2019-04-21
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAMD61312052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program