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Individual

BONNIE REAGAN

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
541 NE 20TH AVE, SUITE210, PORTLAND, OR 97232-2862
(503) 233-6940
(503) 236-2676
Mailing address
2406 NE 19TH, PORTLAND, OR 97212
(503) 287-2089
(503) 236-2676

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14470
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
162032
OR
01
49531
WA DEPT. OF L&I
WA
05
8154130
WA
Enumeration date
02/22/2006
Last updated
07/08/2007
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