Individual
MR. MICHAEL DEAN MALLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-3273
(503) 418-2208
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-3273
(503) 418-2208
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
OR
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA218438
OR
Other
Enumeration date
11/10/2014
Last updated
07/10/2024
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