Provider Demographics
NPI:1053439331
Name:TREGO, ANDREW JASON (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JASON
Last Name:TREGO
Suffix:
Gender:M
Credentials:MD
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 1852
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-1852
Mailing Address - Country:US
Mailing Address - Phone:571-318-3351
Mailing Address - Fax:
Practice Address - Street 1:1414 NW NORTHRUP ST STE 800
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2790
Practice Address - Country:US
Practice Address - Phone:503-414-5599
Practice Address - Fax:503-414-5554
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine