Individual provider · Type 1 NPI

Marisa Jane Wickerath, MD

Family Medicine Physician · Portland, OR

NPI number 1962088641 Active

Practice location

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

Call (503) 494-3427 Map

Fax (503) 494-3457

Mailing address

1400 SW 5th Ave Ste 500
Portland, OR 97201-5537

Specialties and licenses

TaxonomyCodeLicense
Family Medicine Physician Primary 207Q00000XMD221260 (OR)

Family Medicine Physician: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

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About NPI 1962088641

Marisa Jane Wickerath, MD's National Provider Identifier is 1962088641, issued on Mar 22, 2021. The primary taxonomy on file is Family Medicine Physician (207Q00000X), and the practice location is in Portland, OR. The record was last updated on Oct 15, 2026.