Provider Demographics
NPI:1457379505
Name:EDMAN, JENNIFER C (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:C
Last Name:EDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:BAIRD HALL 18 L-587
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-8665
Mailing Address - Fax:503-494-2958
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:BAIRD HALL 18 L-587
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8665
Practice Address - Fax:503-494-2958
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA95342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A953420Medicaid
CA00A953420Medicaid
CA00A953420Medicare PIN