Individual
DR. BRUCE LEEWIWATANAKUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3181 SW SAM JACKSON PARK RD., OHSU, PORTLAND, OR 97239
(503) 494-8211
Mailing address
1400 SW 5TH AVE STE 500, PORTLAND, OR 97201-5537
(866) 617-6855
(503) 346-8015
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
DO197940
OR
2084P0800X
Psychiatry Physician
DO219810
OR
2084P0800X
Psychiatry Physician
OS021227
PA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
DO219810
OR
2084P0804X
Child & Adolescent Psychiatry Physician
OS021227
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2017
Last updated
11/10/2025
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