Coodley, Gregg O
Coodley, Gregg O is an individual health care provider with primary practice located at 2400 Sw Vermont St , Portland OR 97219-1940. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Coodley, Gregg O can be contacted via phone (503) 452-0915.Contact Information
Primary practice address
2400 Sw Vermont St
Portland OR 97219-1940
Phone: (503) 452-0915
Fax: (503) 768-9232
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MD16827 | Oregon |
Profile Details
| NPI number | 1871593491 |
|---|---|
| LBN Legal business name | Coodley, Gregg O |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 26th, 2005 |
| Last updated | Oct 16th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871593491 | NPPES |
| Oregon | MEDICAID | 011812 |
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