Provider Demographics
NPI:1124093281
Name:REAGAN, JOSHUA D (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:D
Last Name:REAGAN
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:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:10330 SE 32ND AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6594
Practice Address - Country:US
Practice Address - Phone:503-513-8950
Practice Address - Fax:503-772-4337
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0186583OtherWA DEPT. OF L&I
OR226869Medicaid
OR116674Medicare ID - Type Unspecified
WA0186583OtherWA DEPT. OF L&I
OR226869Medicaid