Provider Demographics
NPI:1952347528
Name:GILLCRIST, AMY K (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:K
Last Name:GILLCRIST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:18603 WILLAMETTE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1705
Mailing Address - Country:US
Mailing Address - Phone:503-908-1590
Mailing Address - Fax:503-723-2862
Practice Address - Street 1:1750 BLANKENSHIP RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-5101
Practice Address - Country:US
Practice Address - Phone:503-908-1590
Practice Address - Fax:503-723-2862
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2016-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD21800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR139378Medicaid
ORP00252474OtherRR MEDICARE
ORR131020Medicare PIN
ORP00252474OtherRR MEDICARE
ORR136187Medicare PIN