Provider Demographics
NPI:1114923760
Name:REYES, VINCENT P (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:P
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SE 7TH AVE STE 2500
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4157
Mailing Address - Country:US
Mailing Address - Phone:503-844-8280
Mailing Address - Fax:503-346-8449
Practice Address - Street 1:349 SE 7TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4112
Practice Address - Country:US
Practice Address - Phone:503-693-6108
Practice Address - Fax:503-693-6122
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD16883207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR012117Medicaid
ORE49576Medicare UPIN
OR00WDBCDAMedicare ID - Type Unspecified