Provider Demographics
NPI:1811066822
Name:AMEREDES, FAYE E (DO)
Entity type:Individual
Prefix:DR
First Name:FAYE
Middle Name:E
Last Name:AMEREDES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2801 NW MERCY DR STE 340
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2348
Mailing Address - Country:US
Mailing Address - Phone:541-677-4319
Mailing Address - Fax:541-677-2294
Practice Address - Street 1:2460 NW STEWART PARKWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1516
Practice Address - Country:US
Practice Address - Phone:541-677-4463
Practice Address - Fax:541-677-3379
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO22718207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288143Medicaid
ORR113431Medicare PIN
ORF32423Medicare UPIN