Individual
IAN MARQUES HARTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1111 NE 99TH AVE, SUITE 201, PORTLAND, OR 97220-9428
(503) 962-1020
(503) 962-1021
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01148
OR
363AS0400X
Surgical Physician Assistant
PA01148
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500603584
—
OR
Enumeration date
08/02/2006
Last updated
03/11/2021
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