Provider Demographics
NPI:1932270634
Name:MEYERHOFF, JEFFREY D (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:D
Last Name:MEYERHOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2386 NW HOYT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3219
Mailing Address - Country:US
Mailing Address - Phone:503-228-5909
Mailing Address - Fax:503-226-4186
Practice Address - Street 1:2386 NW HOYT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3219
Practice Address - Country:US
Practice Address - Phone:503-228-5909
Practice Address - Fax:503-226-4186
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR072751Medicaid
061577000OtherBC
OR00WFBRMCMedicare PIN
OR0000BKYBMMedicare PIN
061577000OtherBC
OR072751Medicaid
OR114860Medicare PIN