Basic Information
| Provider Information | |||||||||
| NPI: | 1205919958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORCHARD | ||||||||
| FirstName: | REYNOLD | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1776 SW MADISON ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972051715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032241044 | ||||||||
| FaxNumber: | 5036212235 | ||||||||
| Practice Location | |||||||||
| Address1: | 1718 E KESSLER BLVD | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986321842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607475800 | ||||||||
| FaxNumber: | 3605753846 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 06/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD22249 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD00038466 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00893295 | 01 | OR | RR MEDICARE | OTHER | 276324 | 05 | OR | MEDICAID |