MARCUS CORNWALL DOPC NPI 1154514446

NPI Information

NPI: 1154514446
Provider Name: MARCUS CORNWALL, DOPC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 38D2181298

Address:
6542 SE LAKE RD STE 202
MILWAUKIE, OR
ZIP 97222
Phone: (503) 233-5273
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MARCUS CORNWALL, DOPC is a primary care clinic center in Milwaukie, OR. MARCUS CORNWALL, DOPC NPI is 1154514446. The provider is registered as an organization entity type.

The provider's business location address is:

6542 SE LAKE RD STE 202
MILWAUKIE, OR
ZIP 97222-245
Phone: (503) 233-5273
Fax: (855) 492-8902

The provider's authorized official is Marcus H Cornwall .
The authorized official title is Physician And Owner and has the following contact phone number (503) 233-5273.

The CLIA number assigned to this NPI record is 38D2181298 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/21/2007 and was last updated on 12/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	DO23052	OREGON	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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