Provider Demographics
NPI:1467681957
Name:ALL, JAIME WALTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:WALTON
Last Name:ALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:25030 SW PARKWAY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9816
Mailing Address - Country:US
Mailing Address - Phone:503-612-0498
Mailing Address - Fax:503-459-0521
Practice Address - Street 1:25030 SW PARKWAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9816
Practice Address - Country:US
Practice Address - Phone:503-612-0498
Practice Address - Fax:503-459-0521
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012508392085R0202X, 2085R0204X
ORMD1843162085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467681957Medicaid
VAVVH598AMedicare PIN
VA1467681957Medicaid