Provider Demographics
NPI:1831131713
Name:JANSSEN, ANDREA GROUT (MD26115)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:GROUT
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:MD26115
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7529 SE TUALATIN VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-8252
Mailing Address - Country:US
Mailing Address - Phone:503-681-4240
Mailing Address - Fax:503-730-1369
Practice Address - Street 1:7529 SE TUALATIN VALLEY HWY
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-8252
Practice Address - Country:US
Practice Address - Phone:503-681-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213319Medicaid
OR383998Medicare ID - Type UnspecifiedCLINIC RHC NUMBER
OR213319Medicaid