Provider Demographics
NPI:1598127144
Name:PHILLIPS, JESSICA LYNN HADWIN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN HADWIN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11782 SW BARNES RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5933
Mailing Address - Country:US
Mailing Address - Phone:503-214-5200
Mailing Address - Fax:503-906-6613
Practice Address - Street 1:14795 SW MURRAY SCHOLLS DR STE 109
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9230
Practice Address - Country:US
Practice Address - Phone:503-906-4301
Practice Address - Fax:503-906-6613
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD208675207X00000X
390200000X
CODR.0066562207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD208675OtherOREGON MEDICAL LICENSE