Individual
DR. JILL ELIZABETH PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1015 NW 22ND AVENUE, R 200, PORTLAND, OR 97210-3025
(503) 413-8407
(503) 413-7361
Mailing address
1015 NW 22ND AVENUE, R 200, PORTLAND, OR 97210-3025
(503) 413-8407
(503) 413-7361
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD18835
OR
208M00000X
Hospitalist Physician
MD18835
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150774
—
OR
Enumeration date
11/09/2006
Last updated
03/24/2011
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