Healthcare Provider Details

I. General information

NPI: 1841437134
Provider Name (Legal Business Name): CEZARY WOJCIK M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 03/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 SW VERMONT ST OHSU FAMILY MEDICINE AT GABRIEL PARK
PORTLAND OR
97219-1020
US

IV. Provider business mailing address

4411 SW VERMONT ST OHSU FAMILY MEDICINE AT GABRIEL PARK
PORTLAND OR
97219-1020
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-9992
  • Fax:
Mailing address:
  • Phone: 503-494-9992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01069326A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD156949
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: