Provider Demographics
NPI:1619137692
Name:LUBAHN, JESSICA DUAN (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DUAN
Last Name:LUBAHN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:10000 SE MAIN ST
Practice Address - Street 2:SUITE 342
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2448
Practice Address - Country:US
Practice Address - Phone:503-255-5244
Practice Address - Fax:503-255-5120
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2021-12-02
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Provider Licenses
StateLicense IDTaxonomies
ORMD161491208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500657210Medicaid
WA2044440Medicaid
OR180876Medicare PIN
WA2044440Medicaid