Provider Demographics
NPI:1568764363
Name:JERRY E NYE MD PC
Entity Type:Organization
Organization Name:JERRY E NYE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:NYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-274-4865
Mailing Address - Street 1:2311 NW NORTHRUP ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2994
Mailing Address - Country:US
Mailing Address - Phone:503-274-4865
Mailing Address - Fax:503-274-4989
Practice Address - Street 1:2311 NW NORTHRUP ST
Practice Address - Street 2:SUITE 209
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2994
Practice Address - Country:US
Practice Address - Phone:503-274-4865
Practice Address - Fax:503-274-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty