Provider Demographics
NPI:1407248131
Name:WORTHINGTON, JARED (MD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:WORTHINGTON
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 1:811 E BURNSIDE ST
Mailing Address - Street 2:STE 217
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1231
Mailing Address - Country:US
Mailing Address - Phone:503-476-1189
Mailing Address - Fax:
Practice Address - Street 1:811 E BURNSIDE ST
Practice Address - Street 2:STE 217
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1231
Practice Address - Country:US
Practice Address - Phone:989-948-7687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD2032262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program