Provider Demographics
NPI:1871596551
Name:MENASHE, JEFFREY IRVING (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:IRVING
Last Name:MENASHE
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 1:5050 NE HOYT ST
Mailing Address - Street 2:STE 256
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2982
Mailing Address - Country:US
Mailing Address - Phone:503-239-7767
Mailing Address - Fax:503-215-6897
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:STE 256
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2982
Practice Address - Country:US
Practice Address - Phone:503-239-7767
Practice Address - Fax:503-215-6897
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15990207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1021098Medicaid
OR081083Medicaid
WAG8890984Medicare PIN
OR081083Medicaid
WA1021098Medicaid