Healthcare Provider Details

I. General information

NPI: 1750368494
Provider Name (Legal Business Name): RICHARD VIGRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 NE 47TH AVE SUITE 215
PORTLAND OR
97213-2238
US

IV. Provider business mailing address

1460 NE MEDICAL CENTER DR
BEND OR
97701-6061
US

V. Phone/Fax

Practice location:
  • Phone: 503-731-2900
  • Fax:
Mailing address:
  • Phone: 541-382-6633
  • Fax: 541-382-2719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD15262
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: