Healthcare Provider Details

I. General information

NPI: 1043233570
Provider Name (Legal Business Name): MARK ERIC HOSKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 SE POWELL VALLEY RD
GRESHAM OR
97080-1494
US

IV. Provider business mailing address

PO BOX 647
GRESHAM OR
97030-0167
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-5050
  • Fax: 503-666-7410
Mailing address:
  • Phone: 503-666-5050
  • Fax: 503-666-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: