Healthcare Provider Details

I. General information

NPI: 1841228327
Provider Name (Legal Business Name): CORVALLIS FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 NW KINGS BLVD
CORVALLIS OR
97330
US

IV. Provider business mailing address

2400 NW KINGS BLVD
CORVALLIS OR
97330
US

V. Phone/Fax

Practice location:
  • Phone: 541-757-2400
  • Fax: 541-757-4719
Mailing address:
  • Phone: 541-757-2400
  • Fax: 541-757-4719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AARON LEE DAVID
Title or Position: PRESIDENT
Credential: DO
Phone: 541-757-2400