Provider Demographics
NPI:1629584529
Name:RIOUX, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:RIOUX
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 1:3587 HEATHROW WAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4004
Mailing Address - Country:US
Mailing Address - Phone:541-858-8170
Mailing Address - Fax:
Practice Address - Street 1:2808 SE BALFOUR ST
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6426
Practice Address - Country:US
Practice Address - Phone:503-659-2575
Practice Address - Fax:503-659-5182
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR17-CRM-001OtherCERTIFIED RECOVERY MENTOR
ORTHW1723OtherTRADITIONAL HEALTH WORKKER
ORA144604OtherOREGON DRIVERS LICENSE