Healthcare Provider Details

I. General information

NPI: 1033101167
Provider Name (Legal Business Name): JERZY O GIEDWOYN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 NE 99TH AVE SUITE 201
PORTLAND OR
97220-9428
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-962-1000
  • Fax: 503-963-3005
Mailing address:
  • Phone: 503-215-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD07659
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: