Individual
GLENN E. WOODWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, MAIL CODE UHS-2, PORTLAND, OR 97239-3011
(503) 494-7641
(503) 418-0884
Mailing address
3181 SW SAM JACKSON PARK RD, MAIL CODE UHS-2, PORTLAND, OR 97239-3011
(503) 494-7641
(503) 418-0884
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD150997
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G612870
BLUE SHIELD OF CA
CA
05
—
00G612870
—
CA
Enumeration date
08/13/2006
Last updated
08/29/2014
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