Provider Demographics
NPI:1245273374
Name:MELNICK, JEFFREY B (PA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:MELNICK
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 13994
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-0994
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:12442 SW SCHOLLS FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-3396
Practice Address - Country:US
Practice Address - Phone:503-215-9900
Practice Address - Fax:503-216-9266
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORPA00251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant