Individual
SUZANNE JANE GWILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6640 SW REDWOOD LANE, PORTLAND, OR 97224
(503) 620-7358
(503) 624-6144
Mailing address
6640 SW REDWOOD LANE, PORTLAND, OR 97224
(503) 620-7358
(503) 624-6144
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD18381
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063524
—
OR
Enumeration date
09/28/2006
Last updated
06/19/2012
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