Provider Demographics
NPI:1619904257
Name:MOREHART, MARK ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:MOREHART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:15947 WALUGA DR.
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4245
Mailing Address - Country:US
Mailing Address - Phone:503-635-2273
Mailing Address - Fax:503-635-2274
Practice Address - Street 1:15947 WALUGA DR.
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4245
Practice Address - Country:US
Practice Address - Phone:503-635-2273
Practice Address - Fax:503-635-2274
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD25715207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C61399Medicare UPIN