Healthcare Provider Details

I. General information

NPI: 1083697163
Provider Name (Legal Business Name): VANESSA T VU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 MERCY DR STE 200
ROSEBURG OR
97470
US

IV. Provider business mailing address

PO BOX 430
WINCHESTER OR
97495-0430
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-2800
  • Fax: 541-677-2820
Mailing address:
  • Phone: 541-643-2764
  • Fax: 541-677-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD17297
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: