Individual
ELAINE R MARCUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1321 NE 99TH AVE, SUITE 100, PORTLAND, OR 97220-9437
(503) 215-9900
(503) 215-4055
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD22770
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
279160
—
OR
01
—
P00729898
RR MEDICARE
OR
Enumeration date
10/03/2006
Last updated
10/19/2012
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