| Doctor Name: | DR. JEFFREY OWEN PENTECOST |
| NPI Number: | 1861770190 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | DO16894 |
| Business Practice Address: | 3574 Se Harold Ct Portland, OR - 972024344 |
| Business Phone Number: | 5032801621 |
| Business Fax Number: | |
| Mailing Address: | 3574 Se Harold Ct, PORTLAND |
| State: | OR |
| Postal Code: | 972024344 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/03/2011 |
| NPI Last Update Date: | 08/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | DO16894 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |