Provider Demographics
NPI:1215902911
Name:GALLISON, CLAUDIA J (MD)
Entity type:Individual
Prefix:DR
First Name:CLAUDIA
Middle Name:J
Last Name:GALLISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 NW 86TH CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 NW 86TH CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-6417
Practice Address - Country:US
Practice Address - Phone:503-880-8808
Practice Address - Fax:503-225-9002
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14649207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR050040110OtherRR MEDICARE
WA1045376Medicaid
IDG505505Medicaid
MT1215902911Medicaid
OR198325Medicaid
AKMD649ORMedicaid
OR050040110OtherRR MEDICARE
AKMD649ORMedicaid