Healthcare Provider Details

I. General information

NPI: 1306841275
Provider Name (Legal Business Name): KIUMARS MOVASSAGHI MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S GARDEN WAY STE 100
EUGENE OR
97401-8177
US

IV. Provider business mailing address

330 S GARDEN WAY STE 100
EUGENE OR
97401-8177
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-8700
  • Fax: 541-686-9004
Mailing address:
  • Phone: 541-686-8700
  • Fax: 541-686-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: