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General NPI Number Information
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NPI Number | 1801144985
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Entity Type | Organization
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Legal Business Name | TODD GILLINGHAM MD LLC
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 15160 NW LAIDLAW RD SUITE 100
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City | PORTLAND
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State | OR
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Zip | 97229-7707
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Country | US
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Telephone | 503-582-8283
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Fax | 503-582-9004
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Provider Business Mailing Address
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Address Line | 15160 NW LAIDLAW RD SUITE 100
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City | PORTLAND
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State | OR
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Zip | 97229-7707
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Country | US
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Telephone | 503-582-8283
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Fax | 503-582-9004
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Authorized Official
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Title or Position | OWNER
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Name | TODD GILLINGHAM
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Credential | M.D.
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Telephone | 503-582-8283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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