Provider Demographics
NPI:1568488583
Name:REESE, RANDY L (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:L
Last Name:REESE
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:PO BOX 40386
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-0060
Mailing Address - Country:US
Mailing Address - Phone:541-255-3905
Mailing Address - Fax:541-255-3959
Practice Address - Street 1:1755 COBURG RD
Practice Address - Street 2:BLDG. 6B
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4982
Practice Address - Country:US
Practice Address - Phone:541-255-3905
Practice Address - Fax:541-255-3959
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD17594207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR04485-4Medicaid