Individual
TERENA D GIMMILLARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-4860
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO173630
OR
207QA0401X
Addiction Medicine (Family Medicine) Physician
DO173630
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500701579
—
OR
Enumeration date
05/08/2013
Last updated
10/14/2020
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