Active NPI
Jeff Wakeham
- Specialist
- Gresham, OR
National Provider Identifier
1467631374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 4101 NE Division St
Suite # 100
Gresham, OR 97030-4617 - Phone
- (503) 666-3808
- Fax
- (503) 666-6835
- NPI assigned
- Oct 26, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
4101 NE Division St
Suite # 100
Gresham, OR 97030-4617
Mailing address
7540 Charolais CT
Gladstone, OR 97027-1259
Phone (503) 557-7903
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193356800000",
"number": "1467631374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7540 CHAROLAIS CT",
"city": "GLADSTONE",
"state": "OR",
"postal_code": "970271259",
"telephone_number": "503-557-7903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4101 NE DIVISION ST",
"address_2": "SUITE # 100",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970304617",
"telephone_number": "503-666-3808",
"fax_number": "503-666-6835"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAKEHAM",
"first_name": "JEFF",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-26",
"last_updated": "2007-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.