Provider Demographics
NPI:1215094958
Name:REY ROSA, RAGNA KIRSTEN (MD)
Entity type:Individual
Prefix:DR
First Name:RAGNA
Middle Name:KIRSTEN
Last Name:REY ROSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAGNA
Other - Middle Name:KIRSTEN
Other - Last Name:BOYNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5050 SKYLINE VILLAGE LOOP S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9490
Mailing Address - Country:US
Mailing Address - Phone:503-391-1110
Mailing Address - Fax:503-370-4237
Practice Address - Street 1:5050 SKYLINE VILLAGE LOOP S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9490
Practice Address - Country:US
Practice Address - Phone:503-391-1110
Practice Address - Fax:503-370-4237
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
133065Medicare PIN