Provider Demographics
NPI:1770737058
Name:BOICE, JEDEDIAH W
Entity type:Individual
Prefix:
First Name:JEDEDIAH
Middle Name:W
Last Name:BOICE
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 1:1125 NW 9TH AVE
Mailing Address - Street 2:STE 221
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2864
Mailing Address - Country:US
Mailing Address - Phone:503-330-0007
Mailing Address - Fax:503-914-1979
Practice Address - Street 1:1125 NW 9TH AVE
Practice Address - Street 2:STE 221
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2864
Practice Address - Country:US
Practice Address - Phone:503-330-0007
Practice Address - Fax:503-914-1979
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies