Christopher Paul Jacques

Individual provider Active NPI Technician/Technologist · Molalla, OR

NPI 1598030256 · NPPES record last updated Mar 14, 2012

Key facts

NPI
1598030256
Entity type
Individual (NPI type 1)
Primary specialty
Technician/Technologist 156F00000X
Practice address
872 W Main St Apt C27
Molalla, OR 97038-8865
Phone
(503) 984-7899
NPI assigned
Mar 14, 2012
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Technician/Technologist 156F00000X Yes

Addresses

Primary practice location

872 W Main St Apt C27
Molalla, OR 97038-8865

Mailing address

872 W Main St Apt C27
Molalla, OR 97038-8865
Phone (503) 984-7899

Other providers in Molalla, OR

All providers in Molalla, OR · Technician/Technologist in Oregon

Sources for this page

Verify at the official NPI Registry.