Provider Demographics
NPI:1770809303
Name:NORRIS-JACOB, AUDRA RACHELLE (MD)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:RACHELLE
Last Name:NORRIS-JACOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24850 SE STARK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-8320
Mailing Address - Country:US
Mailing Address - Phone:503-491-9444
Mailing Address - Fax:
Practice Address - Street 1:24850 SE STARK ST STE 200
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-8320
Practice Address - Country:US
Practice Address - Phone:503-491-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD168646207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology