Individual
MELINDA MAE MANTOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2801 N GANTENBEIN AVE, PORTLAND, OR 97227-1623
(503) 413-8407
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
DO217033
OR
207R00000X
Internal Medicine Physician
OP61477654
WA
208M00000X
Hospitalist Physician
Primary
DO217033
OR
Other
Enumeration date
04/06/2020
Last updated
10/17/2025
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