Individual
PETER LINDLEY REAGAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
541 NE 20TH AVE, SUITE 210, 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
11379
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1032606
—
WA
05
—
112979
—
OR
01
—
49532
WA DEPT. OF L&I
WA
Enumeration date
02/22/2006
Last updated
07/08/2007
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