Individual
CALLUM HART MACKINTOSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5050 NE HOYT ST STE 359, PORTLAND, OR 97213-2983
(503) 935-8501
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA207556
OR
363AS0400X
Surgical Physician Assistant
PA70030324
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500798393
—
OR
Enumeration date
05/02/2020
Last updated
09/29/2025
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