Basic Information
| Provider Information | |||||||||
| NPI: | 1407827694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOYKE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | MAE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 NE MULTNOMAH ST STE 1 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972322023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419124258 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4855 SW WESTERN AVE | ||||||||
| Address2: | UNIVERSITY OF OREGON | ||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970053460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033504442 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 08/20/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD19236 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 072665 | 05 | OR | MEDICAID | 930069802 | 01 | OR | RAILROAD | OTHER |