Individual
TANYA LYNN WIDMER AYLWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, MAIL CODE: BTE119, PORTLAND, OR 97239-3098
(503) 494-1164
Mailing address
3181 SW SAM JACKSON PARK RD, MAIL CODE: BTE119, PORTLAND, OR 97239-3098
(503) 494-1164
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
56205
AZ
207R00000X
Internal Medicine Physician
MD202426
OR
208M00000X
Hospitalist Physician
Primary
MD202426
OR
Other
Enumeration date
06/25/2013
Last updated
01/05/2021
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