Provider Demographics
NPI:1770516577
Name:REUTHER, CECILLE S (MD)
Entity type:Individual
Prefix:
First Name:CECILLE
Middle Name:S
Last Name:REUTHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CECILLE
Other - Middle Name:S
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:9155 SW BARNES RD
Practice Address - Street 2:STE 333
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6625
Practice Address - Country:US
Practice Address - Phone:503-216-2028
Practice Address - Fax:503-216-2485
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25116207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR233461Medicaid
OR500626956Medicaid
ORP00464785OtherRR MEDICARE
H64780Medicare UPIN
OR233461Medicaid