Provider Demographics
NPI:1528301926
Name:VINCENT A. REGER, MD PC
Entity type:Organization
Organization Name:VINCENT A. REGER, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:REGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-292-2796
Mailing Address - Street 1:9155 SW BARNES RD STE 406
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6641
Mailing Address - Country:US
Mailing Address - Phone:503-292-2796
Mailing Address - Fax:503-291-5438
Practice Address - Street 1:9155 SW BARNES RD STE 406
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6641
Practice Address - Country:US
Practice Address - Phone:503-292-2796
Practice Address - Fax:503-291-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16802208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1699750828OtherNPI NUMBER