Healthcare Provider Details

I. General information

NPI: 1851607246
Provider Name (Legal Business Name): NEWBERG FAMILY PRACTICE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VILLA RD
NEWBERG OR
97132-1857
US

IV. Provider business mailing address

450 VILLA RD
NEWBERG OR
97132-1857
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-7331
  • Fax: 503-538-7333
Mailing address:
  • Phone: 503-538-7331
  • Fax: 503-538-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD14665
License Number StateOR

VIII. Authorized Official

Name: DR. AN CONG VU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 503-538-7331