Healthcare Provider Details

I. General information

NPI: 1457375719
Provider Name (Legal Business Name): BARBARA S MALLETT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19260 SW 65TH AVE SUITE 280
TUALATIN OR
97062-5701
US

IV. Provider business mailing address

19260 SW 65TH AVE SUITE 280
TUALATIN OR
97062-5701
US

V. Phone/Fax

Practice location:
  • Phone: 971-244-8711
  • Fax: 971-200-2400
Mailing address:
  • Phone: 971-244-8711
  • Fax: 971-200-2400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD17507
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: