Individual
MARK S FETTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9155 SW BARNES RD STE 333, PORTLAND, OR 97225-6630
(503) 216-5102
(503) 216-2485
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
35059345
OH
2084P0800X
Psychiatry Physician
Primary
MD175068
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500698053
—
OR
Enumeration date
10/31/2005
Last updated
02/01/2022
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