Provider Demographics
NPI:1407055437
Name:PAUL D. REICHERTER, MD, PC
Entity Type:Organization
Organization Name:PAUL D. REICHERTER, MD, PC
Other - Org Name:ADVANCED SKIN CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:REICHERTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-672-7546
Mailing Address - Street 1:1813 W HARVARD AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2756
Mailing Address - Country:US
Mailing Address - Phone:541-672-7546
Mailing Address - Fax:541-957-8446
Practice Address - Street 1:1813 W HARVARD AVE STE 310
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2756
Practice Address - Country:US
Practice Address - Phone:541-672-7546
Practice Address - Fax:541-957-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23536207N00000X, 207ND0101X, 207NI0002X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric DermatologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286785Medicaid
OR286785OtherOHP
OR838392000OtherBCBS
OR38D1028702OtherCLIA
DC5977OtherMEDICARE RAILROAD
OR286785Medicaid
OR286785OtherOHP