Provider Demographics
NPI:1073600938
Name:VIRAMONTES, JOSE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:VIRAMONTES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:VIRAMONTES
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1460 G ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4112
Mailing Address - Country:US
Mailing Address - Phone:541-988-6330
Mailing Address - Fax:541-988-6340
Practice Address - Street 1:1460 G ST STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4112
Practice Address - Country:US
Practice Address - Phone:541-988-6330
Practice Address - Fax:541-988-6340
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR274802086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR006389Medicaid
OR006389Medicaid