Provider Demographics
NPI:1962454934
Name:MAH, CLIFFORD DONALD (DPM)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:DONALD
Last Name:MAH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12400 NW CORNELL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5693
Mailing Address - Country:US
Mailing Address - Phone:503-643-1737
Mailing Address - Fax:503-643-4926
Practice Address - Street 1:12400 NW CORNELL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5693
Practice Address - Country:US
Practice Address - Phone:503-643-1737
Practice Address - Fax:503-643-4926
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDP00369213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery