Individual
MARK WILLIAM MANOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11782 SW BARNES ROAD, SUITE 300, PORTLAND, OR 97225
(503) 214-5200
(503) 906-6613
Mailing address
11782 SW BARNES ROAD, SUITE 300, PORTLAND, OR 97225
(503) 214-5200
(503) 906-6613
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
MD175044
OR
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
MD175044
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500710871
—
OR
01
—
LICENSE #
MD175044
OR
Enumeration date
02/09/2006
Last updated
05/23/2022
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