Provider Demographics
NPI:1588759203
Name:MECKLER, GARTH DAVID (MD)
Entity type:Individual
Prefix:
First Name:GARTH
Middle Name:DAVID
Last Name:MECKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:935 SE 16TH AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2666
Mailing Address - Country:US
Mailing Address - Phone:503-432-8451
Mailing Address - Fax:
Practice Address - Street 1:OHSU DEPARTMENT OF EMERGENCY MEDICINE CDW EM
Practice Address - Street 2:3181 SW SAM JACKSON PARK ROAD
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3098
Practice Address - Country:US
Practice Address - Phone:503-494-7123
Practice Address - Fax:503-494-4997
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA793532080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A793530Medicaid
CA00A793530Medicaid
CAH30848Medicare UPIN