Individual
DR. MARK A. PETROFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17720 JEAN WAY, SUITE100, LAKE OSWEGO, OR 97035-5394
(503) 635-4886
(503) 635-1655
Mailing address
17720 JEAN WAY, SUITE100, LAKE OSWEGO, OR 97035-5394
(503) 635-4886
(503) 635-1655
Taxonomy
Speciality
Code
Description
License number
State
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
Primary
MD15996
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069609
—
OR
01
—
MD15996
STATE LICENSE
OR
Enumeration date
07/26/2005
Last updated
03/07/2023
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