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Individual

PAUL DOUGLAS REICHERTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1813 W HARVARD AVE, STE 310, ROSEBURG, OR 97471-2752
(541) 672-7546
(541) 957-8446
Mailing address
1813 W HARVARD AVE, STE 310, ROSEBURG, OR 97471-2752
(541) 672-7546
(541) 957-8446

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
2015039802
MO
207N00000X
Dermatology Physician
MD23536
OR
207ND0101X
MOHS-Micrographic Surgery Physician
2015039802
MO
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
MD23536
OR
207ND0900X
Dermatopathology Physician
2015039802
MO
207ND0900X
Dermatopathology Physician
MD23536
OR
207NP0225X
Pediatric Dermatology Physician
2015039802
MO
207NP0225X
Pediatric Dermatology Physician
MD23536
OR
207NS0135X
Procedural Dermatology Physician
2015039802
MO
207NS0135X
Procedural Dermatology Physician
MD23536
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1053379826
MO
05
286785
OR
01
38D1028702
CLIA #
OR
01
838392000
BLUE CROSS
OR
01
DC5977
RAILROAD MEDICARE
OR
Enumeration date
05/02/2006
Last updated
03/17/2018
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