Healthcare Provider Details

I. General information

NPI: 1609817592
Provider Name (Legal Business Name): D. TIMOTHY MCCARLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DENNIS T. MCCARLEY M.D.

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MULLINS DR STE C1
LEBANON OR
97355-2868
US

IV. Provider business mailing address

PO BOX 1189
CORVALLIS OR
97339-1189
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-7450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD22772
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: