Provider Demographics
NPI:1477530152
Name:GOINS, CHAD R (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:R
Last Name:GOINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4137
Mailing Address - Country:US
Mailing Address - Phone:503-640-3708
Mailing Address - Fax:503-693-0441
Practice Address - Street 1:512 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4137
Practice Address - Country:US
Practice Address - Phone:503-640-3708
Practice Address - Fax:503-693-0441
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28655207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR026201Medicaid
WA8314437Medicaid
ORMD28655OtherOREGON STATE MEDICAL LICENSE
WA0161189OtherL AND I
WA0161189OtherL AND I
H66826Medicare UPIN
OR026201Medicaid