Healthcare Provider Details

I. General information

NPI: 1023013620
Provider Name (Legal Business Name): RICHARD B HALBUR PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 04/12/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 SPAULDING AVE
BROWNSVILLE OR
97327-0160
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-6940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA165019
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: