Provider Demographics
NPI:1609213461
Name:DUNN, JACQUELYN ROSE (DO)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:ROSE
Last Name:DUNN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12264 NW KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-4942
Mailing Address - Country:US
Mailing Address - Phone:503-990-9106
Mailing Address - Fax:
Practice Address - Street 1:1130 NW 22ND AVE STE 220
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2969
Practice Address - Country:US
Practice Address - Phone:503-413-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO179110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty