Provider Demographics
NPI:1245572684
Name:STILL, GORDON GRAY (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:GRAY
Last Name:STILL
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 1:5024 SW BUDDINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7372
Mailing Address - Country:US
Mailing Address - Phone:919-605-7448
Mailing Address - Fax:
Practice Address - Street 1:501 N GRAHAM ST STE 330A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2001
Practice Address - Country:US
Practice Address - Phone:503-413-2050
Practice Address - Fax:503-413-2026
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE29551207RS0012X, 2080S0012X
ORMD209666208000000X, 2080S0012X, 2080P0214X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine