Fettman, Mark S

Fettman, Mark S is an individual health care provider with primary practice located at 9155 Sw Barnes Rd Ste 333 , Portland OR 97225-6630. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Fettman, Mark S can be contacted via phone (503) 216-5102.

Contact Information

Primary practice address
9155 Sw Barnes Rd Ste 333 Portland OR 97225-6630
Phone: (503) 216-5102
Fax: (503) 216-2485
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 35059345 Ohio
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X MD175068 Oregon

Profile Details

NPI number 1043201981
LBN Legal business name Fettman, Mark S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 31st, 2005
Last updated Feb 1st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043201981 NPPES
Oregon MEDICAID 500698053

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