Provider Demographics
NPI:1063615672
Name:MCCALL, JENNIFER LYNN FILE (DO)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN FILE
Last Name:MCCALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:FILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-1303
Mailing Address - Fax:503-346-8021
Practice Address - Street 1:3181 SW SAM JACKSON PARK ROAD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-1303
Practice Address - Fax:503-346-8021
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10054208000000X
ORDO126209208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1134146939Medicaid