Individual
JILL T WALWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4805 NE GLISAN ST, SUITE BG05, PORTLAND, OR 97213-2933
(503) 215-2393
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD21892
OR
208M00000X
Hospitalist Physician
Primary
MD21892
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
288314
—
OR
01
—
P00465312
RR MEDICARE
OR
Enumeration date
07/19/2006
Last updated
03/25/2021
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