JACOB PATRICK DOUGHERTY DO
NPI 1063263739
Student in an Organized Health Care Education/Training Program in Portland, OR
About Jacob Patrick Dougherty Do NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACOB PATRICK DOUGHERTY DO (NPI 1063263739) is an individual student in an organized health care education/training program in Portland, Oregon and active in the NPI registry since March 2024. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jacob Patrick Dougherty Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
PORTLAND, OR 97239
PORTLAND, OR 97239
PORTLAND, OR 97239
PORTLAND, OR 97239
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jacob Dougherty's NPI number?
The NPI number for Jacob Dougherty is 1063263739. It was assigned to this individual provider in the NPPES registry on March 29, 2024.
Where is Jacob Dougherty located?
Jacob Dougherty practices at 3181 SW Sam Jackson Park Rd, Portland, OR 97239. The listed phone number is (503) 494-8211.
What is Jacob Dougherty's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Jacob Dougherty enrolled in Medicare?
Yes. Jacob Dougherty is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Jacob Dougherty was last updated on March 29, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jacob Patrick Dougherty, DO · NPI 1063263739
Student in an Organized Health Care Education/Training Program provider in Portland, Oregon. Individual provider, active in the CMS NPPES registry since March 29, 2024.
## Identity
- **NPI:** 1063263739 (Entity type: Individual)
- **Enumerated:** March 29, 2024
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** No
## Practice location
- **Address:** 3181 SW SAM JACKSON PARK RD, Portland, OR 97239-3098
- **Phone:** (503) 494-8211
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for durable medical equipment, power mobility devices
## Record status
- **NPPES last updated:** March 29, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1063263739) · Data from the CMS NPPES public registry.