Individual
ANNIE SEAPAN MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9555 SW BARNES RD STE 255, PORTLAND, OR 97225-6654
(503) 908-1590
(503) 723-2862
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD27041
OR
208000000X
Pediatrics Physician
Primary
MD27041
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500633407
—
OR
Enumeration date
07/14/2006
Last updated
04/03/2024
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