Provider Demographics
NPI:1598725004
Name:MEYER, MARY MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:MEYER
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 1:2330 NW FLANDERS ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3442
Mailing Address - Country:US
Mailing Address - Phone:503-226-6678
Mailing Address - Fax:503-226-4307
Practice Address - Street 1:2330 NW FLANDERS ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3442
Practice Address - Country:US
Practice Address - Phone:503-226-6678
Practice Address - Fax:503-226-4307
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16338207R00000X, 207RC0200X, 207RN0300X, 207RP1001X
WAMD00042977207R00000X, 207RC0200X, 207RN0300X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OROMAP001854Medicaid
OROMAP001854Medicaid
ORR134796Medicare PIN