Healthcare Provider Details

I. General information

NPI: 1700701885
Provider Name (Legal Business Name): ALEC GOLDAMMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 14TH AVE SE
ALBANY OR
97322-8513
US

IV. Provider business mailing address

225 TIMBER RIDGE ST SE APT 159
ALBANY OR
97322-7417
US

V. Phone/Fax

Practice location:
  • Phone: 541-791-9566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPI-0014699
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: