Provider Demographics
NPI:1306862388
Name:BACKMAN, JENNIFER (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BACKMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 KAEN RD
Mailing Address - Street 2:SUITE 367
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4035
Mailing Address - Country:US
Mailing Address - Phone:503-742-5300
Mailing Address - Fax:503-742-5979
Practice Address - Street 1:25 JACOBS GULCH RD
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2023
Practice Address - Country:US
Practice Address - Phone:208-784-1221
Practice Address - Fax:208-784-0961
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO25595207Q00000X
IDO-1192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8458721Medicaid
WAI58503Medicare UPIN
WA8861175Medicare PIN