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General NPI Number Information
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NPI Number | 1891960860
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Entity Type | Individual
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Provider Name | MARK S. YERBY MD
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Gender | Male
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 830 NE 47TH AVE
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City | PORTLAND
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State | OR
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Zip | 97213-2212
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Country | US
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Telephone | 503-978-0178
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Fax | 503-286-7939
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Provider Business Mailing Address
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Address Line | 8316 N LOMBARD ST PMB 324
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City | PORTLAND
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State | OR
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Zip | 97203-3727
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Country | US
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Telephone | 503-978-0178
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Fax | 503-286-7939
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MD10835
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | MD10835
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License Number State | OR
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