Provider Demographics
NPI:1386607414
Name:NEILSON, DUNCAN REESE JR (MD)
Entity type:Individual
Prefix:
First Name:DUNCAN
Middle Name:REESE
Last Name:NEILSON
Suffix:JR
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 1:300 N GRAHAM ST
Mailing Address - Street 2:STE 100 MEDICAL PLAZA BLDG LEGACY EMANUEL HOSPITAL
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227
Mailing Address - Country:US
Mailing Address - Phone:503-413-3622
Mailing Address - Fax:503-413-4238
Practice Address - Street 1:300 N GRAHAM ST
Practice Address - Street 2:STE 100 MEDICAL PLAZA BLDG LEGACY EMANUEL HOSPITAL
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1683
Practice Address - Country:US
Practice Address - Phone:503-413-3622
Practice Address - Fax:503-413-4238
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08860207V00000X
WAMD00045703207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR136762Medicaid
OR136762Medicaid
130509Medicare ID - Type Unspecified