Individual
FAWN MELANIE WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9155 SW BERNES RD., SUITE 638, PORTLAND, OR 97225
(503) 216-7000
(503) 216-6940
Mailing address
9155 SW BERNES RD., SUITE 638, PORTLAND, OR 97225
(503) 216-7000
(503) 216-6940
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD25195
OR
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MD25195
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277859
—
OR
Enumeration date
04/05/2006
Last updated
03/25/2021
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