Healthcare Provider Details

I. General information

NPI: 1083653679
Provider Name (Legal Business Name): WILLIAM C. CHAPIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 SE MAIN ST SUITE 1001
PORTLAND OR
97216-2455
US

IV. Provider business mailing address

PO BOX 92900
PORTLAND OR
97292-0900
US

V. Phone/Fax

Practice location:
  • Phone: 503-255-3404
  • Fax:
Mailing address:
  • Phone: 503-255-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD22016
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD22016
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: