Provider Demographics
NPI:1902861909
Name:DENSON, MARILYNN JANICE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYNN
Middle Name:JANICE
Last Name:DENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MARILYNN
Other - Middle Name:J
Other - Last Name:DENSON-WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3777
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3777
Mailing Address - Country:US
Mailing Address - Phone:503-413-3900
Mailing Address - Fax:
Practice Address - Street 1:24800 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3378
Practice Address - Country:US
Practice Address - Phone:503-491-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045450207V00000X
KS0431517207V00000X
TXM4757207V00000X
MN52432207V00000X
IN01062277A207V00000X
ORMD218352207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1525781Medicaid
MI0M37200001Medicare ID - Type Unspecified
MI1525781Medicaid