Provider Demographics
NPI:1538116314
Name:JORDHEN, LAURA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:JORDHEN
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 1:1350 NE 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-2011
Mailing Address - Country:US
Mailing Address - Phone:503-408-7010
Mailing Address - Fax:
Practice Address - Street 1:10201 SE MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2937
Practice Address - Country:US
Practice Address - Phone:503-255-2186
Practice Address - Fax:503-255-2194
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044347207Q00000X
ORMD151292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8417917Medicaid
WA8417917Medicaid
ORR155861Medicare PIN