Individual
MILTON C MACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10000 SE MAIN ST, SUITE 316, PORTLAND, OR 97216-2448
(503) 256-1575
(503) 253-9848
Mailing address
10000 SE MAIN ST, SUITE 316, PORTLAND, OR 97216-2448
(503) 256-1575
(503) 253-9848
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD18652
OR
2086S0129X
Vascular Surgery Physician
MD18652
OR
208C00000X
Colon & Rectal Surgery Physician
MD18652
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127220
—
OR
Enumeration date
03/28/2006
Last updated
01/25/2011
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