DR. DOUGLAS REED GROSSNICKLE (NPI# 1669418810) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669418810 |
| Entity Type | Individual |
| Full Name | DR. DOUGLAS REED GROSSNICKLE |
| Credential | MD |
| Practice Address |
10373 Ne Hancock Suite 219 Portland OR 97220 |
| Mailing Address |
10113 Se Cleone Ct Portland OR 97266 |
| Practice Telephone | 5037757407 |
| Practice Fax Number | 5037751547 |
| Mailing Telephone | 5037757407 |
| Mailing Fax Number | 5037751547 |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
MD13084 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 264119 | 05 |
| Street Address |
10373 NE HANCOCK SUITE 219 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972638211 | Douglas Bald | Surgery | 10373 Ne Hancock, Ste 118, Portland, OR 97220 | 2007-02-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316569254 | Debra Shamblin | Behavioral Analyst | 150 Ne 100th Ave, Portland, OR 97220 | 2020-05-14 |
| 1336780618 | Joan Lambert | Technician | 2802 Ne 108th Avenue, Portland, OR 97220 | 2019-10-08 |
| 1750933917 | Multnomah County | Clinic/Center | 11540 Ne Inverness Dr., Inverness Jail, Portland, OR 97220 | 2019-07-09 |
| 1194223107 | Landmark Connect of Oregon PC | General Practice | 5933 Ne Win Sivers Dr Ste 310, Portland, OR 97220 | 2018-01-24 |
| 1487178711 | Andrew Shonk | Massage Therapist | 163 Ne 102nd Ave Blid V, Portland, OR 97220 | 2017-07-28 |
| 1548781693 | Greater New Hope Family Services | Lodging | 11868 Ne Sandy Blvd, Portland, OR 97220 | 2017-06-29 |
| 1245771740 | Maria Teresa Banez Salcedo | Registered Nurse | 10300 Ne Hancock Street, Portland, OR 97220 | 2017-03-16 |
| 1568901858 | Christopher Gabriel Lyons | Adult Companion | 1343 Ne 118 Ave. Apt5, Portland, OR 97220 | 2017-02-20 |
| 1962945956 | Linda Ann Oldenburg | Registered Nurse | 9515 Ne Skidmore Avenue, Portland, OR 97220 | 2016-11-23 |
| 1326493446 | Trent D. Wilson | Massage Therapist | 8401 Ne Halsey St., Suite 101, Portland, OR 97220 | 2016-04-26 |
| Find all providers in zip 97220 | ||||
| Taxonomy Code | 207RG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Geriatric Medicine |
| An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093916470 | Kellie Rooney Foster | Internal Medicine | 2710 Nw Vaughn St, Suite 160, Portland, OR 97210-5344 | 2007-05-31 |
| 1447310859 | Karen Kruse | Internal Medicine | 8200 Se Barbara Welch Rd, Portland, OR 97236-5335 | 2006-12-08 |
| 1083729214 | Stephen Arnold Ebert | Internal Medicine | 2701 Nw Vaughn St., Suite 160, Portland, OR 97201 | 2006-08-20 |
| 1609892736 | Paul Gowen | Internal Medicine | 3635 Ne Alameda St, Portland, OR 97212-1812 | 2006-07-14 |
| 1457324949 | George Goodstein | Internal Medicine | 5100 Sw Macadam Ave, Suite 200, Portland, OR 97239-6102 | 2006-02-07 |
| 1497757447 | Luis Felipe Rodriguez | Internal Medicine | 13007 Ne Glisan St, Portland, OR 97230-2545 | 2005-08-10 |
| 1518372606 | Paul R Porter Md | Internal Medicine | 934 S Broadway St, Ste 3, Portland, TN 37148-1700 | 2014-06-26 |
| 1093128571 | Lisa Kendell Sanders | Internal Medicine | 5050 Ne Hoyt St Ste 540, Portland, OR 97213 | 2014-06-03 |
| 1457642373 | Sandhya Venkata Srikantom | Internal Medicine | 3710 Sw Us Veterans Hospital Rd, Attn P3med, Portland, OR 97239-2964 | 2011-04-26 |
| 1386835981 | Maria Dulce Regina Tomas Zarraga | Internal Medicine | 2222 Nw Lovejoy St, Suite 315, Portland, OR 97210 | 2007-08-08 |
| Find all providers in PORTLAND | ||||
Please comment or provide details below to improve the information on DR. DOUGLAS REED GROSSNICKLE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.