Provider Demographics
NPI:1164429130
Name:GANDLER, HOWARD I (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:I
Last Name:GANDLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 NW PETTYGROVE
Mailing Address - Street 2:#120
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-223-1840
Mailing Address - Fax:503-274-8970
Practice Address - Street 1:2230 NW PETTYGROVE
Practice Address - Street 2:#120
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-223-1840
Practice Address - Fax:503-274-8970
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17774207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR042825Medicaid
OR042825Medicaid
ORR0000BKFJKMedicare ID - Type Unspecified