Healthcare Provider Details

I. General information

NPI: 1710098181
Provider Name (Legal Business Name): PETER A HINCKLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE AVALON PL
CORVALLIS OR
97330-9258
US

IV. Provider business mailing address

600 NE AVALON PL
CORVALLIS OR
97330-9258
US

V. Phone/Fax

Practice location:
  • Phone: 541-745-5053
  • Fax: 503-391-7422
Mailing address:
  • Phone: 541-745-5053
  • Fax: 503-391-7422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD18129
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: