Provider Demographics
NPI:1891974705
Name:WORTHINGTON, JEFF
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:WORTHINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MORTON RD
Mailing Address - Street 2:# 101
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1578
Mailing Address - Country:US
Mailing Address - Phone:503-799-1941
Mailing Address - Fax:
Practice Address - Street 1:4101 NE DIVISION ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-4617
Practice Address - Country:US
Practice Address - Phone:503-666-3808
Practice Address - Fax:503-666-6835
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist