Individual
DR. MARK S. YERBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
830 NE 47TH AVE, PORTLAND, OR 97213-2212
(503) 978-0178
(503) 286-7939
Mailing address
8316 N LOMBARD ST, PMB 324, PORTLAND, OR 97203-3727
(503) 978-0178
(503) 286-7939
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD10835
OR
2084V0102X
Vascular Neurology Physician
MD10835
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000BJBPV
MEDICARE
OR
05
—
060160
—
OR
01
—
099529000
BLUE CROSS
OR
01
—
1170059
WA MEDICAID
WA
01
—
K72601
PACIFICSOURCE
OR
01
—
R0000BJBPV
GROUP MEDICARE
OR
Enumeration date
04/29/2008
Last updated
02/29/2016
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