Provider Demographics
NPI:1831408053
Name:TAYLOR, JASON PAUL (PA-C)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:PAUL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8122 SE TIBBETTS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1768
Mailing Address - Country:US
Mailing Address - Phone:503-777-5995
Mailing Address - Fax:503-777-8005
Practice Address - Street 1:8122 SE TIBBETTS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-1768
Practice Address - Country:US
Practice Address - Phone:503-777-5995
Practice Address - Fax:503-777-5995
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORPA167838363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant