Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | MD00044900 | WA |
Y | 2080P0210X | Pediatric Nephrologist | MD25092 | OR |
NPI | 1710955018 |
---|---|
Provider Name | Dr. Edward Nigel Guillery |
First Address | Portland, OR 97227-1654 |
Second Address | Portland, OR 97227-1654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 04/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
275191 | (05) | OR |