Provider Demographics
NPI:1871682245
Name:JOSSI, PAGE GRIFFIN (MD)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:GRIFFIN
Last Name:JOSSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAGE
Other - Middle Name:BYNUM
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5100 S MACADAM AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3827
Mailing Address - Country:US
Mailing Address - Phone:971-202-5500
Mailing Address - Fax:971-202-5555
Practice Address - Street 1:5100 S MACADAM AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3827
Practice Address - Country:US
Practice Address - Phone:971-202-5500
Practice Address - Fax:971-202-5555
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR067463006OtherREGENCE
OR133955Medicaid
911019392OtherCOMMERCIAL
MO665 12OtherPACIFIC SOURCE
911019392OtherCOMMERCIAL
103897Medicare ID - Type UnspecifiedRR MEDICARE
OR133955Medicaid