Individual
EDUARDO A VIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5005 NE SANDY BLVD, PORTLAND, OR 97213-1941
(503) 233-6940
(503) 236-2676
Mailing address
800 SW 13TH AVE, PORTLAND, OR 97205-1902
(503) 221-0161
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00038051
WA
207R00000X
Internal Medicine Physician
Primary
OR-MD27304
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
247628
—
OR
05
—
8252769
—
WA
01
—
P00418274
RAILROAD MEDICARE
OR
Enumeration date
12/27/2005
Last updated
12/29/2020
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