NPI 1790749422 · live from the CMS NPI Registry
Tyler Justin Gluckman, M.D.
Internal Medicine, Cardiovascular Disease in Portland, OR. National Provider Identifier 1790749422, active.
NPI record
| NPI | 1790749422 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Internal Medicine, Cardiovascular Disease 207RC0000X |
| Practice location | 9427 Sw Barnes Rd, Suite 498, Portland, OR 97225 |
| Practice phone | 503-216-0900 |
| Mailing address | Po Box 3158, Portland, OR 97208 |
| Enumerated | April 12, 2006 |
| Last updated | December 18, 2012 |
| Sole proprietor | No |
| Other names | Ty Gluckman |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Internal Medicine, Cardiovascular Disease | 207RC0000X | D0058894 (MD) |
| Internal Medicine, Cardiovascular Disease primary | 207RC0000X | MD26695 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.