Individual
MARK L SHATSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
18040 SW LOWER BOONES FERRY RD, SUITE 100, TIGARD, OR 97224-7258
(503) 216-0700
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO25748
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269756
—
OR
01
—
P00252349
RR MEDICARE
OR
Enumeration date
07/13/2006
Last updated
03/25/2021
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