Individual
MARY E MEADOWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12710 SE DIVISION ST, PORTLAND, OR 97236-3134
(503) 988-3601
Mailing address
421 SW OAK ST., STE. 210, PORTLAND, OR 97204
(503) 988-3663
(503) 988-3015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD23233
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22959
—
OR
05
—
287264
—
OR
01
—
80175454
RR MEDICARE
OR
Enumeration date
06/03/2006
Last updated
01/12/2012
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