Provider Demographics
NPI:1013065721
Name:DREW, MARY JO (MD)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:DREW
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 1:3131 N. VANCOUVER AVE.
Mailing Address - Street 2:AMERICAN RED CROSS PNW REGIONAL BLOOD SERVICES
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227
Mailing Address - Country:US
Mailing Address - Phone:503-528-5920
Mailing Address - Fax:
Practice Address - Street 1:3131 N. VANCOUVER AVE.
Practice Address - Street 2:AMERICAN RED CROSS PNW REGIONAL BLOOD SERVICES
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227
Practice Address - Country:US
Practice Address - Phone:503-528-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27873207ZB0001X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD067302OtherCHAMPUS-CHAMPUS
MI325225310Medicaid
700H262270OtherBLUE CROSS-BLUE CROSS
MD067302OtherCOMMERCIAL-COMMERCIAL NUMBER
MI325225310Medicaid
700H262270OtherBLUE CROSS-BLUE CROSS