Provider Demographics
NPI:1477846608
Name:DE VERA, RENSIE CHIARA R (MD)
Entity Type:Individual
Prefix:
First Name:RENSIE CHIARA
Middle Name:R
Last Name:DE VERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:541-687-6011
Mailing Address - Fax:541-302-4733
Practice Address - Street 1:1200 HILYARD ST
Practice Address - Street 2:SUITE 230
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8122
Practice Address - Country:US
Practice Address - Phone:541-687-6011
Practice Address - Fax:541-302-4733
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD166626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program