Provider Demographics
NPI:1750837779
Name:REINAUER, MALLORI BETH (MD)
Entity type:Individual
Prefix:DR
First Name:MALLORI
Middle Name:BETH
Last Name:REINAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MALLORI
Other - Middle Name:BETH
Other - Last Name:JIRIKOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10123 SE MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2532
Mailing Address - Country:US
Mailing Address - Phone:503-257-2500
Mailing Address - Fax:
Practice Address - Street 1:10123 SE MARKET ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2532
Practice Address - Country:US
Practice Address - Phone:503-257-2500
Practice Address - Fax:503-251-6293
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11420227-1205207L00000X
ORMD213501207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology