Individual
MARY K. TEGGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
619 NW 6TH AVE FL 3, PORTLAND, OR 97209-3964
(503) 988-5020
(503) 988-5022
Mailing address
619 NW 6TH AVE FL 5, PORTLAND, OR 97209-3964
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
152807
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
01
—
152807
OREGON PA LICENSE
OR
Enumeration date
08/02/2006
Last updated
01/14/2020
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