Provider Demographics
NPI:1922001023
Name:ANDERSEN, JAY CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:CHRISTOPHER
Last Name:ANDERSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 SW BARNES RD
Mailing Address - Street 2:STE 150
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6663
Mailing Address - Country:US
Mailing Address - Phone:503-297-7403
Mailing Address - Fax:503-384-9908
Practice Address - Street 1:9555 SW BARNES RD
Practice Address - Street 2:STE 150
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6663
Practice Address - Country:US
Practice Address - Phone:503-297-7403
Practice Address - Fax:503-384-9908
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25119207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022597Medicaid
WA1022183Medicaid
WA1022183Medicaid
OR022597Medicaid
ORH57721Medicare UPIN