Healthcare Provider Details

I. General information

NPI: 1497720460
Provider Name (Legal Business Name): MICHAEL HUGH MCQUEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 POCAHONTAS RD
BAKER CITY OR
97814-1464
US

IV. Provider business mailing address

PO BOX 1365
SILVERTON OR
97381-0349
US

V. Phone/Fax

Practice location:
  • Phone: 541-523-8111
  • Fax:
Mailing address:
  • Phone: 541-786-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD20138
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: