Provider Demographics
NPI:1083697163
Name:VU, VANESSA T (MD)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:T
Last Name:VU
Suffix:
Gender:F
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:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:OR
Mailing Address - Zip Code:97495-0430
Mailing Address - Country:US
Mailing Address - Phone:541-643-2764
Mailing Address - Fax:541-677-2820
Practice Address - Street 1:2801 MERCY DR
Practice Address - Street 2:STE 200
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470
Practice Address - Country:US
Practice Address - Phone:541-677-2800
Practice Address - Fax:541-677-2820
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17297207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR028584Medicaid
1083697163OtherNPI
108310Medicare ID - Type Unspecified
OR028584Medicaid