Individual
MARLO L. MCILRAITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15220 NW LAIDLAW RD STE 100, PORTLAND, OR 97229-7717
(503) 418-2000
Mailing address
15220 NW LAIDLAW RD, PORTLAND, OR 97229-7716
(503) 418-2415
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD22169
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134289
—
OR
Enumeration date
07/31/2006
Last updated
12/06/2011
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