Provider Demographics
NPI:1427213164
Name:WALLNER, CLARE FRANCISCO (MD)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:FRANCISCO
Last Name:WALLNER
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 1:222 SW HARRISON ST
Mailing Address - Street 2:TOWNHOUSE 2
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201
Mailing Address - Country:US
Mailing Address - Phone:808-208-4623
Mailing Address - Fax:
Practice Address - Street 1:222 SW HARRISON ST
Practice Address - Street 2:TOWNHOUSE 2
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201
Practice Address - Country:US
Practice Address - Phone:808-208-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT192860207P00000X
HIMD17097207P00000X
OR154096207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine