Provider Demographics
NPI:1053411660
Name:SULTANY, GARY L (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:SULTANY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:9155 SW BARNES RD STE 314
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6630
Mailing Address - Country:US
Mailing Address - Phone:503-297-3384
Mailing Address - Fax:503-297-0863
Practice Address - Street 1:9155 SW BARNES RD STE 314
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6630
Practice Address - Country:US
Practice Address - Phone:503-297-3384
Practice Address - Fax:503-297-0863
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD13316207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR267799Medicaid
OROOWCPHRBMedicare ID - Type Unspecified
ORC93883Medicare UPIN