# PACIFIC VASCULAR SPECIALISTS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164478780
- **Authorized official:** DR. JOHN W WIEST MD (OWNER)
- **Authorized official phone:** (707) 289-2968

## Contact information

- **Practice address:** 9155 SW BARNES RD, STE 321, PORTLAND, OR 97225
- **Practice address phone:** (707) 289-2968
- **Practice address fax:** (503) 719-8253
- **Mailing address:** PO BOX 3571, SEATTLE, WA 98124-3571
- **Mailing address phone:** (707) 289-2968
- **Mailing address fax:** (503) 719-8253

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | MD14474 | OR | Yes |

## Other

- **Enumeration date:** 05/25/2006
- **Last updated:** 05/04/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 278874 | — | OR |
| 01 | — | R109778 | PTAN | OR |