Provider Information for 1619416625
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JAYE BAHRE
Sex: Female
NPI: 1619416625
Last Updated: 2017-02-23
Certification Date:
Certification Date:
Details
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NPI | 1619416625 | ||||||||
Enumeration Date | 2017-02-23 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | 3587 HEATHROW WAY MEDFORD, OR 97504-4004 United States Phone: 541-858-8170 | Fax: | ||||||||
Primary Practice Address | 17720 NE HALSEY ST STE B PORTLAND, OR 97230-6771 United States Phone: 503-654-7654 | Fax:503-654-7333 | ||||||||
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