Individual provider · Type 1 NPI

Michael Dean Mallon

Medical Physician Assistant · Portland, OR

NPI number 1194121715 Active

Practice location

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011

Call (503) 494-3273 Map

Fax (503) 418-2208

Other practice locations

  • 3415 SE Powell Blvd, Portland, OR 97202-3371 · (503) 234-9591
  • 2730 S Moody Ave, Portland, OR 97201-5042 · (503) 725-3442

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA218438 (OR)
Counselor 101Y00000XNone listed
Physician Assistant 363A00000XNone listed

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About NPI 1194121715

Michael Dean Mallon's National Provider Identifier is 1194121715, issued on Nov 10, 2014. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Portland, OR. The record was last updated on Jul 10, 2024.