Active NPI
Suzanne Jane Gwilliam, MD
- Family Medicine Physician
- Portland, OR
National Provider Identifier
1942392097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD18381
- Practice address
- 6640 SW Redwood Lane
Portland, OR 97224 - Phone
- (503) 620-7358
- Fax
- (503) 624-6144
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD18381 | OR | Primary |
Addresses
Primary practice location
6640 SW Redwood Lane
Portland, OR 97224
Mailing address
6640 SW Redwood Lane
Portland, OR 97224
Phone (503) 620-7358
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 063524 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340064000000",
"number": "1942392097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6640 SW REDWOOD LANE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97224",
"telephone_number": "503-620-7358",
"fax_number": "503-624-6144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6640 SW REDWOOD LANE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97224",
"telephone_number": "503-620-7358",
"fax_number": "503-624-6144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GWILLIAM",
"first_name": "SUZANNE",
"middle_name": "JANE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-28",
"last_updated": "2012-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OR",
"license": "MD18381",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "063524",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.