Healthcare Provider Details

I. General information

NPI: 1801801394
Provider Name (Legal Business Name): MARK LAWRENCE SILEN MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2552 NW MILDRED ST
PORTLAND OR
97210-3337
US

IV. Provider business mailing address

2552 NW MILDRED ST
PORTLAND OR
97210-3337
US

V. Phone/Fax

Practice location:
  • Phone: 503-310-9611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD22074
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: