Provider Demographics
NPI:1053395160
Name:OREILLY, SIOBHAN A (DO)
Entity type:Individual
Prefix:
First Name:SIOBHAN
Middle Name:A
Last Name:OREILLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1700
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0414
Mailing Address - Country:US
Mailing Address - Phone:541-464-5400
Mailing Address - Fax:541-464-5411
Practice Address - Street 1:272 MEDICAL LOOP
Practice Address - Street 2:SUITE B
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5597
Practice Address - Country:US
Practice Address - Phone:541-464-5400
Practice Address - Fax:541-464-5411
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO19967207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR082797Medicaid
ORR100334Medicare PIN
OR082797Medicaid