Provider Demographics
NPI:1215972765
Name:WEEKS, JEFFREY P (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:WEEKS
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:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:12442 SW SCHOLLS FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-0803
Practice Address - Country:US
Practice Address - Phone:503-215-9900
Practice Address - Fax:503-216-9219
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR264259Medicaid
ORP00663008OtherRR MEDICARE
ORP00663008OtherRR MEDICARE
ORR136541Medicare PIN
ORC94047Medicare UPIN
ORR161676Medicare PIN
ORR161675Medicare PIN
ORR157641Medicare PIN
ORR159639Medicare PIN
ORR152706Medicare PIN