Jacob Lythgoe
Radiology, Diagnostic Radiology in Portland, OR. Individual provider (NPI-1).
NPI number1164041620
StatusActive
Last updated in NPPESJun 18, 2025
Details
- NPI
- 1164041620
- Entity type
- Individual (NPI-1)
- Name
- Jacob Lythgoe
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 14, 2020
- Certification date
- Jun 18, 2025
- Last updated
- Jun 18, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085R0202X | Radiology, Diagnostic Radiology | MD224317 | OR | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
3181 Sw Sam Jackson Park RdPortland, OR 97239-3011
Phone 503-418-0990
Mailing address
3181 Sw Sam Jackson Park RdPortland, OR 97239-3011
Phone 503-418-0990
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