Provider Demographics
NPI:1477752194
Name:MARK J. MORROW, MD
Entity type:Organization
Organization Name:MARK J. MORROW, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-292-5322
Mailing Address - Street 1:9427 SW BARNES RD
Mailing Address - Street 2:STE 595
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6652
Mailing Address - Country:US
Mailing Address - Phone:503-292-5322
Mailing Address - Fax:503-296-9856
Practice Address - Street 1:9427 SW BARNES RD
Practice Address - Street 2:STE 595
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6652
Practice Address - Country:US
Practice Address - Phone:503-292-5322
Practice Address - Fax:503-296-9856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25974174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213526Medicaid
F20539Medicare UPIN
ORR132704Medicare PIN