Provider Demographics
NPI:1477505105
Name:OKEEFE, GWENDOLYN B (MD)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:B
Last Name:OKEEFE
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 1:3303 S BOND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-1100
Mailing Address - Fax:503-494-1110
Practice Address - Street 1:3303 S BOND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-1100
Practice Address - Fax:503-494-1110
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD205744207R00000X, 2083C0008X, 208M00000X
WAMD60055138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8968047OtherMEDICARE PIN
WA1477505105Medicaid
G73341Medicare UPIN
0046R73601Medicare ID - Type Unspecified