Healthcare Provider Details

I. General information

NPI: 1467249789
Provider Name (Legal Business Name): ANTHONY LI MD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW SAMARITAN DR
CORVALLIS OR
97330-5472
US

IV. Provider business mailing address

3517 NW SAMARITAN DR STE 201
CORVALLIS OR
97330-3769
US

V. Phone/Fax

Practice location:
  • Phone: 541-768-4906
  • Fax:
Mailing address:
  • Phone: 541-768-5142
  • Fax: 541-768-5355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPG225587
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: