Individual
SAMUEL R. GLICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
25050 SE STARK STREET, LEGACY MT HOOD MULTISPECIALTY CLINIC, GRESHAM, OR 97030
(503) 413-5702
(503) 413-6499
Mailing address
25050 SE STARK STREET, LEGACY MT HOOD MULTISPECIALTY CLINIC, GRESHAM, OR 97030
(503) 413-5702
(503) 413-6499
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
MD177588
OR
208M00000X
Hospitalist Physician
265576
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2009
Last updated
08/23/2016
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