Individual
MADISON MARIE MABRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
5050 NE HOYT ST STE 340, PORTLAND, OR 97213-2983
(503) 238-1061
(503) 238-0841
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA213704
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2226231
—
WA
05
—
500812454
—
OR
Enumeration date
05/22/2020
Last updated
05/15/2026
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