Healthcare Provider Details

I. General information

NPI: 1811060122
Provider Name (Legal Business Name): MARK E HELM MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 WELCH ST
SILVERTON OR
97381-1946
US

IV. Provider business mailing address

891 23RD ST NE
SALEM OR
97301-1793
US

V. Phone/Fax

Practice location:
  • Phone: 503-400-0454
  • Fax: 503-334-2268
Mailing address:
  • Phone: 503-364-2181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD163504
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500663994
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: