Individual
MARY SARA MINETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
707 SW GAINES ST, PEDIATRIC CARDIOLOGY, CDRC-P, PORTLAND, OR 97239-2901
(503) 494-2192
(503) 494-2824
Mailing address
707 SW GAINES ST, PEDIATRIC CARDIOLOGY, CDRC-P, PORTLAND, OR 97239-2901
(503) 494-2192
(503) 494-2824
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
MD19772
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150183
—
OR
Enumeration date
07/31/2006
Last updated
12/28/2011
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