Organization
PACIFIC VASCULAR SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN W WIEST MD (OWNER)
(707) 289-2968
Entity
Organization
Contact information
Practice address
9155 SW BARNES RD, STE 321, PORTLAND, OR 97225
(707) 289-2968
(503) 719-8253
Mailing address
PO BOX 3571, SEATTLE, WA 98124-3571
(707) 289-2968
(503) 719-8253
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
MD14474
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278874
—
OR
01
—
R109778
PTAN
OR
Enumeration date
05/25/2006
Last updated
05/04/2021
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