Provider Demographics
NPI:1073659579
Name:FLATHMAN, MARK EDWARD
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:EDWARD
Last Name:FLATHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2087 NW OVERTON ST
Mailing Address - Street 2:APT 11
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1660
Mailing Address - Country:US
Mailing Address - Phone:503-209-8197
Mailing Address - Fax:
Practice Address - Street 1:2270 NW OVERTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2927
Practice Address - Country:US
Practice Address - Phone:503-241-6051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered372600000XNursing Service Related ProvidersAdult Companion