Healthcare Provider Details

I. General information

NPI: 1376540799
Provider Name (Legal Business Name): RICHARD CARL DAVIES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N GRANT ST
CANBY OR
97013-3610
US

IV. Provider business mailing address

12303 S CASTO RD
OREGON CITY OR
97045-9550
US

V. Phone/Fax

Practice location:
  • Phone: 503-266-2066
  • Fax: 503-263-8719
Mailing address:
  • Phone: 503-266-2066
  • Fax: 503-263-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO10013
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: