Healthcare Provider Details

I. General information

NPI: 1336100890
Provider Name (Legal Business Name): RICHARD HOWELL AMES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N 5TH ST STE 200
LEBANON OR
97355-2875
US

IV. Provider business mailing address

PO BOX 1193
CORVALLIS OR
97339-1193
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-6282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO24020
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: