Individual
DR. DOUGLAS REED GROSSNICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10373 NE HANCOCK, SUITE 219, PORTLAND, OR 97220
(503) 775-7407
(503) 775-1547
Mailing address
10113 SE CLEONE CT, PORTLAND, OR 97266
(503) 775-7407
(503) 775-1547
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
MD13084
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
264119
—
OR
Enumeration date
06/22/2006
Last updated
07/08/2007
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