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General NPI Number Information
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NPI Number | 1770774598
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Entity Type | Individual
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Provider Name | DAWN BEVERLY MAUTNER MD
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Gender | Female
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 115 NE MAY LN
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City | MCMINNVILLE
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State | OR
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Zip | 97128-9272
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Country | US
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Telephone | 503-472-1338
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Fax | 503-434-8597
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Provider Business Mailing Address
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Address Line | PO BOX 6149
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City | BEAVERTON
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State | OR
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Zip | 97007-0149
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Country | US
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Telephone | 503-352-8657
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Fax | 503-352-8658
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD440181
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License Number State | PA
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