Individual
DR. LAURA MELLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
25 NW 23RD PL, SUITE 11, PORTLAND, OR 97210-5580
(503) 305-6262
(503) 305-6078
Mailing address
PO BOX 5275, PORTLAND, OR 97208-5275
(888) 828-3196
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD17993
OR
208D00000X
General Practice Physician
Primary
MD17993
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057252
—
OR
01
—
208975
WA L & I
—
05
—
8182214
—
WA
01
—
858543007
REGENCE BC/BS
—
Enumeration date
04/10/2006
Last updated
09/06/2012
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