Provider Demographics
NPI:1639156375
Name:LAWLOR, JENNIFER K (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:K
Last Name:LAWLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1040 NW 22ND AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3057
Mailing Address - Country:US
Mailing Address - Phone:503-413-6294
Mailing Address - Fax:503-413-7780
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3057
Practice Address - Country:US
Practice Address - Phone:503-413-6294
Practice Address - Fax:503-413-7780
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2024-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD20535208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150335Medicaid
OR150335Medicaid
G48031Medicare UPIN