Provider Demographics
NPI:1710955018
Name:GUILLERY, EDWARD NIGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:NIGEL
Last Name:GUILLERY
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 1:501 N GRAHAM ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1654
Mailing Address - Country:US
Mailing Address - Phone:503-280-3620
Mailing Address - Fax:503-282-2395
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:SUITE 340
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-280-3620
Practice Address - Fax:503-282-2395
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000449002080P0210X
ORMD250922080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275191Medicaid
ORE92187Medicare UPIN
OR119023Medicare ID - Type Unspecified