Provider Demographics
NPI:1619842648
Name:DWELLE, JULES JOEL
Entity type:Individual
Prefix:
First Name:JULES
Middle Name:JOEL
Last Name:DWELLE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13636 SW PACKARD LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6897
Mailing Address - Country:US
Mailing Address - Phone:503-442-6120
Mailing Address - Fax:
Practice Address - Street 1:300 N GRAHAM ST, MEDICAL OFFICE BLDG 3
Practice Address - Street 2:STE 420
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-276-6154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR114500172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker