Provider Demographics
NPI:1861534075
Name:MAILHOT, MARK FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:FRANCIS
Last Name:MAILHOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 NE WEIDLER ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1121
Mailing Address - Country:US
Mailing Address - Phone:314-888-5233
Mailing Address - Fax:619-984-4301
Practice Address - Street 1:220 NE WEIDLER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1121
Practice Address - Country:US
Practice Address - Phone:314-888-5233
Practice Address - Fax:619-984-4301
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00047492207R00000X
ORMD194698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8473431Medicaid
WA8473431Medicaid
WA8863931Medicare PIN