MEDICARE: TERESA F GIPSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD19918	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265444871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA F GIPSON MD

Provider Business Mailing Address
First Line	:	PO BOX 568
Second Line	:
City	:	CORNELIUS
State	:	OR
Zip	:	97113-0568
Country	:	US
Telephone Number	:	503-352-8657
Fax Number	:	503-352-8658

Provider Business Practice Location Address
First Line	:	226 SE 8TH AVE
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-4218
Country	:	US
Telephone Number	:	503-601-7385
Fax Number	:	503-601-7325

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	11/16/2015

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