Provider Demographics
NPI:1952307183
Name:GIFFORD, JOSEPH R (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:GIFFORD
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 1:34019 RIVER VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-6399
Mailing Address - Country:US
Mailing Address - Phone:541-567-3797
Mailing Address - Fax:
Practice Address - Street 1:1050 W ELM AVE
Practice Address - Street 2:STE 110
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-2713
Practice Address - Country:US
Practice Address - Phone:541-567-2995
Practice Address - Fax:541-567-7720
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276278Medicaid
OR084164000OtherREGENCE BCBSO
OR109963Medicare ID - Type UnspecifiedPROVIDER GROUP #
OR084164000OtherREGENCE BCBSO
ORC91256Medicare UPIN
OR276278Medicaid
OR38-3856Medicare ID - Type UnspecifiedRHC PROVIDER