Provider Demographics
NPI:1487635371
Name:SPIES, JESSICA A (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:SPIES
Suffix:
Gender:F
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 230457
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97281-0457
Mailing Address - Country:US
Mailing Address - Phone:503-906-7300
Mailing Address - Fax:503-245-8219
Practice Address - Street 1:9750 SW NIMBUS AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7172
Practice Address - Country:US
Practice Address - Phone:503-906-7300
Practice Address - Fax:503-245-8219
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27878207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500623434Medicaid
OR500623434Medicaid