Healthcare Provider Details

I. General information

NPI: 1932397353
Provider Name (Legal Business Name): DARRELL D PRINS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 NE WEST DEVILS LAKE RD
LINCOLN CITY OR
97367-5131
US

IV. Provider business mailing address

3011 NE WEST DEVILS LAKE RD
LINCOLN CITY OR
97367-5131
US

V. Phone/Fax

Practice location:
  • Phone: 541-994-2222
  • Fax: 541-996-5601
Mailing address:
  • Phone: 541-994-2222
  • Fax: 541-996-5601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDP00257
License Number StateOR

VIII. Authorized Official

Name: DR. DARRELL D PRINS
Title or Position: OWNER
Credential: DPM
Phone: 541-994-2222