Individual
SANJIV M PANWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9205 SW BARNES RD FL 1, PORTLAND, OR 97225-6603
(503) 216-2906
(503) 216-4114
Mailing address
PO BOX 2077, PORTLAND, OR 97208-2077
(503) 413-3900
(503) 413-3710
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00032898
WA
207R00000X
Internal Medicine Physician
MD22303
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288194
—
OR
01
—
P00443367
RR MEDICARE
OR
Enumeration date
07/01/2006
Last updated
06/27/2018
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