Individual
MARK JOHN MERKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
707 SW GAINES ST, PORTLAND, OR 97239-2901
(800) 452-3563
Mailing address
1 ICARUS LOOP, LAKE OSWEGO, OR 97035-1055
(503) 494-2753
(503) 494-6868
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD16324
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001219
—
OR
Enumeration date
08/03/2006
Last updated
11/17/2011
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