Provider Demographics
NPI:1205819893
Name:VICK, HAROLD G (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:G
Last Name:VICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19250 SW 65TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7452
Mailing Address - Country:US
Mailing Address - Phone:503-692-1242
Mailing Address - Fax:503-691-3615
Practice Address - Street 1:19250 SW 65TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7452
Practice Address - Country:US
Practice Address - Phone:503-692-1242
Practice Address - Fax:503-691-3615
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD 08697207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR238063Medicaid
OR238063Medicaid
ORE 33733Medicare UPIN