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Individual

REGAN REA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.C

Contact information

Practice address
4920 N INTERSTATE AVE, PORTLAND, OR 97217-3653
(503) 215-3300
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00721
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
067463008
REGENCE
OR
05
500604207
OR
01
911019392
COMMERCIAL
01
M0665 17
PACIFIC SOURCE
Enumeration date
10/12/2006
Last updated
11/08/2012
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