Healthcare Provider Details

I. General information

NPI: 1184602112
Provider Name (Legal Business Name): MARY ELIZABETH SKRYPZAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 SW BARNES RD SUITE 150
PORTLAND OR
97225-6772
US

IV. Provider business mailing address

7650 SW BEVELAND RD SUITE 200
PORTLAND OR
97223-8692
US

V. Phone/Fax

Practice location:
  • Phone: 503-734-3535
  • Fax: 503-734-3530
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD00029754
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD28930
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: