Healthcare Provider Details

I. General information

NPI: 1205889391
Provider Name (Legal Business Name): RONALD EUGENE CULVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 VILLA RD SUITE 116
NEWBERG OR
97132-1830
US

IV. Provider business mailing address

308 VILLA RD SUITE 116
NEWBERG OR
97132-1830
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-7407
  • Fax: 503-537-0640
Mailing address:
  • Phone: 503-538-7407
  • Fax: 503-537-0640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD23445
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: