Provider Demographics
NPI:1831144674
Name:VITT, PAUL C (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:VITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S WALL ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-3233
Mailing Address - Country:US
Mailing Address - Phone:541-435-7200
Mailing Address - Fax:541-888-0025
Practice Address - Street 1:150 S WALL ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-3233
Practice Address - Country:US
Practice Address - Phone:541-435-7200
Practice Address - Fax:541-888-0025
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO170327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500672642Medicaid
MO208732701Medicaid
MO268606Medicare PIN
B33963Medicare UPIN
MO6030000Medicare ID - Type Unspecified
268606Medicare Oscar/Certification
MO208732701Medicaid
MO34556013Medicaid
MO268606Medicare Oscar/Certification