Healthcare Provider Details

I. General information

NPI: 1346388543
Provider Name (Legal Business Name): WILLIAM JOHN MAYER QMHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 NW CORNELL RD
PORTLAND OR
97229-5442
US

IV. Provider business mailing address

14255 SW BRIGADOON CT STE 80
BEAVERTON OR
97005-3368
US

V. Phone/Fax

Practice location:
  • Phone: 503-645-9581
  • Fax:
Mailing address:
  • Phone: 503-641-1475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: