Healthcare Provider Details

I. General information

NPI: 1528626389
Provider Name (Legal Business Name): MARISSA CHLOE PALMOR MD, MBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S BOND AVE FL 10
PORTLAND OR
97239-4501
US

IV. Provider business mailing address

3303 S BOND AVE FL 10
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD.MD.61405782
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD213821
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: