Provider Demographics
NPI:1518942093
Name:GILCHRIST, DOHERTY BRESNAHAN (MD)
Entity Type:Individual
Prefix:
First Name:DOHERTY
Middle Name:BRESNAHAN
Last Name:GILCHRIST
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 1:2280 MARCOLA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2594
Mailing Address - Country:US
Mailing Address - Phone:541-747-4300
Mailing Address - Fax:541-747-0655
Practice Address - Street 1:21 HAYDEN BRIDGE WAY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1305
Practice Address - Country:US
Practice Address - Phone:541-741-1226
Practice Address - Fax:541-741-0673
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20672207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150506Medicaid
ORG55416Medicare UPIN
OR150506Medicaid