Provider Demographics
NPI:1790906410
Name:SEGALL, JOCELYN A (MD)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:A
Last Name:SEGALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 NW 11TH AVE
Mailing Address - Street 2:#915
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2776
Mailing Address - Country:US
Mailing Address - Phone:503-227-9167
Mailing Address - Fax:
Practice Address - Street 1:MT TALBERT MEDICAL OFFICE
Practice Address - Street 2:10100 SE SUNNYSIDE ROAD
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015
Practice Address - Country:US
Practice Address - Phone:503-652-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26224208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery