Provider Demographics
NPI:1194883330
Name:WALKEY, MARILYN MILLS (MD, LAC)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:MILLS
Last Name:WALKEY
Suffix:
Gender:F
Credentials:MD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7875 SW ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9336
Mailing Address - Country:US
Mailing Address - Phone:503-608-8155
Mailing Address - Fax:503-244-3015
Practice Address - Street 1:7875 SW ALDEN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-9336
Practice Address - Country:US
Practice Address - Phone:503-608-8155
Practice Address - Fax:503-244-3015
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01190171100000X
ORMD18470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR279345OtherDMAP (OREGON HEALTH PLAN)