Grossnickle, Douglas Reed

Grossnickle, Douglas Reed is an individual health care provider with primary practice located at 10373 Ne Hancock Suite 219, Portland OR 97220. He recently has only one registered license in Allopathic & Osteopathic Physicians / Geriatric Medicine, which is considered as his primary health care specialty. Grossnickle, Douglas Reed can be contacted via phone (503) 775-7407.

Contact Information

Primary practice address
10373 Ne Hancock Suite 219 Portland OR 97220
Phone: (503) 775-7407
Fax: (503) 775-1547
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X MD13084 Oregon

Profile Details

NPI number 1669418810
LBN Legal business name Grossnickle, Douglas Reed
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669418810 NPPES
Oregon MEDICAID 264119

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