DR. MARK A. PETROFF (NPI# 1528068129) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528068129 |
| Entity Type | Individual |
| Full Name | DR. MARK A. PETROFF |
| Credential | M.D. |
| Practice Address |
17720 Jean Way Suite100 Lake Oswego OR 97035-5394 |
| Practice Telephone | 5036354886 |
| Practice Fax Number | 5036351655 |
| Mailing Telephone | 5036354886 |
| Mailing Fax Number | 5036351655 |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2082S0099X |
Plastic Surgery Specialization: Plastic Surgery Within the Head and Neck |
MD15996 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | DEA | AP2351459 | 01 |
| OR | 069609 | 05 | |
| OR | STATE LICENSE | MD15996 | 01 |
| Street Address |
17720 JEAN WAY SUITE100 |
| City | LAKE OSWEGO |
| State | OR |
| Zip Code | 97035-5394 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144365941 | Mark A. Petroff, Md PC | Plastic Surgery | 17720 Jean Way, #100, Lake Oswego, OR 97035-5574 | 2007-02-20 |
| 1093708265 | Larry Bowden | Dentist | 17720 Jean Way, Lake Oswego, OR 97035-5394 | 2005-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932700127 | Teresa Siebenaler Scott | Social Worker | 3990 Sw Collins Way, Suite 202, Lake Owsego, OR 97035 | 2020-11-04 |
| 1528671567 | Martin Henry Lees | Internal Medicine | 14 Morningview Lane, Lake Oswego, OR 97035 | 2020-08-28 |
| 1356976187 | Premere Rehab LLC | Occupational Therapist | Infinity Rehab - The Springs At Lake Oswego, 3900 Kruse Way Pl, Lake Oswego, OR 97035 | 2020-03-12 |
| 1689212193 | Jennifer Chauvin | Nurse Practitioner | 20 Juarez Street, Lake Oswego, OR 97035 | 2019-12-16 |
| 1003396888 | Sarah Guenzburger | Physical Therapist | 3900 Kruse Way Pl, Lake Oswego, OR 97035 | 2018-08-21 |
| 1568964252 | Brett Johnson | Marriage & Family Therapist | 5655 Southwood Dr, Lake Oswego, OR 97035 | 2018-03-08 |
| 1912416561 | Michael Paul Long | Social Worker | 14523 Westlake Drive, Lake Oswego, Or 97035, Lake Oswego, OR 97035 | 2017-09-27 |
| 1467807859 | Misty Lohn | Nurse Practitioner | 5 Centerpointe Dr., Ste 600, Lake Oswego, OR 97035 | 2016-05-04 |
| 1326405473 | Kelsey Prince | Behavioral Analyst | 6400 Sw Rosewood St., Portland (lake Oswego), OR 97035 | 2016-01-20 |
| 1942683388 | Elizabeth Risberg Harrison | Massage Therapist | 190 Oswego Summit, Lake Oswego, OR 97035 | 2015-07-02 |
| Find all providers in zip 97035 | ||||
| Taxonomy Code | 2082S0099X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Plastic Surgery |
| Specialization | Plastic Surgery Within the Head and Neck |
| A plastic surgeon with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgery is practiced, there are many additional procedures which interface with them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Plastic Surgery, 2007. http://www.abplsurg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Plastic Surgery. A subspecialty certificate was approved by the ABMS in 2000. ACGME Accredited Residency Program Requirements: None. |
| City | LAKE OSWEGO |
| Zip Code | 97035 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.