Provider Demographics
NPI:1700467479
Name:GOLDMAN, JAMIE LEE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SW 6TH AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1605
Mailing Address - Country:US
Mailing Address - Phone:971-940-7170
Mailing Address - Fax:971-386-1081
Practice Address - Street 1:400 SW 6TH AVE STE 501
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1605
Practice Address - Country:US
Practice Address - Phone:971-940-7170
Practice Address - Fax:971-386-1081
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date: