Provider Demographics
NPI:1215431960
Name:LUCK, MARISSA BONUS (MD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:BONUS
Last Name:LUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:LUCK
Other - Last Name:BONUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:OREGON HEALTH & SCIENCE UNVERSITY
Mailing Address - Street 2:3181 SW SAM JACKSON PARK RD
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-418-4500
Mailing Address - Fax:503-418-3708
Practice Address - Street 1:OREGON HEALTH & SCIENCE UNIVERSITY
Practice Address - Street 2:3181 SW SAM JACKSON PARK RD
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:312-926-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2025-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD209009207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology