Individual
PHYLLIS C GILMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
18610 NW CORNELL RD, SUITE 101, HILLSBORO, OR 97124-9204
(503) 216-9360
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD23420
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00468705
RR MEDICARE
OR
Enumeration date
06/21/2006
Last updated
07/14/2014
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