Provider Demographics
NPI:1871819078
Name:MIERAS, JAMIE (DPM)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MIERAS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3777
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3777
Mailing Address - Country:US
Mailing Address - Phone:503-413-3900
Mailing Address - Fax:503-413-3710
Practice Address - Street 1:25050 SE STARK ST
Practice Address - Street 2:STE 265
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3327
Practice Address - Country:US
Practice Address - Phone:503-413-2005
Practice Address - Fax:503-413-3699
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE 5094213ES0103X
COPOD.0000736213ES0103X
ORDP181086213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO329089YXFBOtherMEDICARE