Healthcare Provider Details

I. General information

NPI: 1790737799
Provider Name (Legal Business Name): HUSSEIN A HURAIBI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW SAMARITAN DR
CORVALLIS OR
97330-5472
US

IV. Provider business mailing address

PO BOX 87966
CANTON MI
48187-0966
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-5111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4301066286
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number4301066286
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD214569
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: