Dr. Tyler Justin Gluckman III, M.D.
Internal Medicine, Cardiovascular Disease in Portland, OR. Individual provider (NPI-1).
NPI number1790749422
StatusActive
Last updated in NPPESDec 18, 2012
Details
- NPI
- 1790749422
- Entity type
- Individual (NPI-1)
- Name
- Dr. Tyler Justin Gluckman III
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 12, 2006
- Last updated
- Dec 18, 2012
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - CARDIOVASCULAR DISEASE (CARDIOLOGY)
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RC0000X | Internal Medicine, Cardiovascular Disease | MD26695 | OR | Yes |
| 207RC0000X | Internal Medicine, Cardiovascular Disease | D0058894 | MD |
Other names
- Ty Justin Gluckman (Other Name)
Practice location
9427 Sw Barnes RdSuite 498
Portland, OR 97225-6652
Phone 503-216-0900
Mailing address
Po Box 3158Portland, OR 97208-3158
Phone 503-215-6494 · Fax 503-215-6644
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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