Healthcare Provider Details

I. General information

NPI: 1467582031
Provider Name (Legal Business Name): KAREN WEISMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 NW KINGS BLVD
CORVALLIS OR
97330-3925
US

IV. Provider business mailing address

2310 NW KINGS BLVD
CORVALLIS OR
97330-3925
US

V. Phone/Fax

Practice location:
  • Phone: 541-754-1530
  • Fax: 541-754-1534
Mailing address:
  • Phone: 541-754-1530
  • Fax: 541-754-1534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License NumberMD19502
License Number StateOR

VIII. Authorized Official

Name: DR. KAREN LEE WEISMAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 541-754-1530