Individual
MALLORY MARIE MCNICHOLAS DOTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10000 SE MAIN ST, SUITE 112, PORTLAND, OR 97216-2448
(503) 255-3054
(503) 255-7651
Mailing address
10000 SE MAIN ST, SUITE 112, PORTLAND, OR 97216-2448
(503) 255-3054
(503) 255-7651
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA01405
OR
Other
Enumeration date
10/21/2008
Last updated
02/25/2025
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