Provider Demographics
NPI:1619173085
Name:WON, REGINA S (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:S
Last Name:WON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24800 SE STARK ST FL 3
Mailing Address - Street 2:LEGACY MEDICINE INPATIENT SERVICE
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3378
Mailing Address - Country:US
Mailing Address - Phone:503-674-1122
Mailing Address - Fax:
Practice Address - Street 1:24800 SE STARK ST FL 3
Practice Address - Street 2:LEGACY MEDICINE INPATIENT SERVICE
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-674-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD161903207R00000X, 207RI0200X
WAMD60490733207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine