Provider Demographics
NPI:1821227760
Name:ARENAS, IVAN AUGUSTO (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:AUGUSTO
Last Name:ARENAS
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13129
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-1129
Mailing Address - Country:US
Mailing Address - Phone:503-814-0273
Mailing Address - Fax:
Practice Address - Street 1:885 MISSION ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6222
Practice Address - Country:US
Practice Address - Phone:503-814-0273
Practice Address - Fax:503-814-0299
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122824207R00000X, 207RC0000X
ORMD205530207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine