Provider Demographics
NPI:1043351992
Name:MERTZ, KATRIA LAUREL (MD)
Entity Type:Individual
Prefix:
First Name:KATRIA
Middle Name:LAUREL
Last Name:MERTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:OREGON MEDICAL GROUP
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-242-4026
Mailing Address - Fax:541-242-4364
Practice Address - Street 1:330 S GARDEN WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8176
Practice Address - Country:US
Practice Address - Phone:541-686-7007
Practice Address - Fax:541-726-5028
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28661207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR246547Medicaid
R158108Medicare PIN