Individual
MEGAN LEAR MUDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
417 SW 117TH AVE, SUITE 100, PORTLAND, OR 97225-5924
(503) 216-1800
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101243296
VA
207Q00000X
Family Medicine Physician
036118322
IL
207Q00000X
Family Medicine Physician
04-34032
KS
207Q00000X
Family Medicine Physician
Primary
MD164511
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528250131
—
VA
05
—
500676578
—
OR
Enumeration date
08/16/2007
Last updated
03/22/2021
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