Individual
MARY BETH HORRALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
15950 SW MILLIKAN WAY, BEAVERTON, OR 97006
(503) 646-0161
(503) 643-7459
Mailing address
800 SW 13TH AVE, PORTLAND, OR 97205-1902
(503) 221-0161
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD16301
OR
208000000X
Pediatrics Physician
MD4098
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005582
—
OR
Enumeration date
09/27/2006
Last updated
11/12/2020
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