Provider Demographics
NPI:1457375719
Name:MALLETT, BARBARA S (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:S
Last Name:MALLETT
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 1:19260 SW 65TH AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-5701
Mailing Address - Country:US
Mailing Address - Phone:971-244-8711
Mailing Address - Fax:971-200-2400
Practice Address - Street 1:19260 SW 65TH AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-5701
Practice Address - Country:US
Practice Address - Phone:971-244-8711
Practice Address - Fax:971-200-2400
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17507174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00473073OtherRAILROAD MEDICARE PTAN
A68451Medicare UPIN
ORR134971Medicare PIN