Healthcare Provider Details

I. General information

NPI: 1467675009
Provider Name (Legal Business Name): CYNTHIA GULICK, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 SW GREENBURG RD
TIGARD OR
97223
US

IV. Provider business mailing address

11900 SW GREENBURG RD
TIGARD OR
97223-6453
US

V. Phone/Fax

Practice location:
  • Phone: 503-620-5556
  • Fax: 503-624-0118
Mailing address:
  • Phone: 503-620-5556
  • Fax: 503-624-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO20679
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO14860
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD28256
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00425
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00890
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00941
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00474
License Number StateOR
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number096007344
License Number StateOR
# 9
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number91007287
License Number StateOR
# 10
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number079044143N1
License Number StateOR
# 11
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number095006531
License Number StateOR
# 12
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number200350075
License Number StateOR
# 13
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO15813
License Number StateOR

VIII. Authorized Official

Name: MRS. CYNTHIA GULICK
Title or Position: OWNER
Credential: DO
Phone: 503-620-5556