Petroff, Mark A.

Petroff, Mark A. is an individual health care provider with primary practice located at 17720 Jean Way Suite100, Lake Oswego OR 97035-5394. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery Within the Head and Neck, which is considered as his primary health care specialty. Petroff, Mark A. can be contacted via phone (503) 635-4886.

Contact Information

Primary practice address
17720 Jean Way Suite100 Lake Oswego OR 97035-5394
Phone: (503) 635-4886
Fax: (503) 635-1655
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery Within the Head and Neck 2082S0099X MD15996 Oregon

Profile Details

NPI number 1528068129
LBN Legal business name Petroff, Mark A.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2005
Last updated Mar 7th, 2023 - about 3 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 1528068129 NPPES
Oregon Other MD15996 STATE LICENSE
Oregon MEDICAID 069609 STATE LICENSE

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