Provider Demographics
NPI:1467672394
Name:REISS, BETTY EVE (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:EVE
Last Name:REISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:BETTY
Other - Middle Name:EVE
Other - Last Name:STEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 N INTERSTATE AVE
Mailing Address - Street 2:KAISER PERMANENTE INTERSTATE MEDICAL OFFICE CENTRAL
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1106
Mailing Address - Country:US
Mailing Address - Phone:503-813-2000
Mailing Address - Fax:
Practice Address - Street 1:3600 N INTERSTATE AVE
Practice Address - Street 2:KAISER PERMANENTE INTERSTATE MEDICAL OFFICE CENTRAL
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1106
Practice Address - Country:US
Practice Address - Phone:503-813-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08692208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics