Provider Demographics
NPI:1336154855
Name:JEFFREYS, TIMOTHY JAY (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAY
Last Name:JEFFREYS
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 1:1510 DIVISION ST STE 280
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-2550
Mailing Address - Country:US
Mailing Address - Phone:503-905-3400
Mailing Address - Fax:503-905-3399
Practice Address - Street 1:1510 DIVISION ST STE 280
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2550
Practice Address - Country:US
Practice Address - Phone:503-905-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15623208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR008321Medicaid
F10262Medicare UPIN