Basic Information
| Provider Information | |||||||||
| NPI: | 1861755126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILLIS | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4103 MERCANTILE DR | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970352556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038509940 | ||||||||
| FaxNumber: | 5038506709 | ||||||||
| Practice Location | |||||||||
| Address1: | 4103 MERCANTILE DR | ||||||||
| Address2: | |||||||||
| City: | LAKE OSWEGO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038509940 | ||||||||
| FaxNumber: | 5038506709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2012 | ||||||||
| LastUpdateDate: | 05/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | DO193270 | OR | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207X00000X | DO193270 | OR | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | PG157927 | OR | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.