MEDICARE: MICHELLE L. MEARS, MD , P.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD19086	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376788315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELLE L. MEARS, MD , P.C

Provider Business Mailing Address
First Line	:	10395 NW GLENCOE RD
Second Line	:	SUITE 200
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-8208
Country	:	US
Telephone Number	:	503-647-9400
Fax Number	:	503-647-5120

Provider Business Practice Location Address
First Line	:	10395 NW GLENCOE RD
Second Line	:	SUITE 200
City	:	NORTH PLAINS
State	:	OR
Zip	:	97133-8208
Country	:	US
Telephone Number	:	503-647-9400
Fax Number	:	503-647-5120

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE L MEARS
Credential	:	M.D.
Telephone Number	:	503-647-9400

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	12/04/2008

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