Healthcare Provider Details

I. General information

NPI: 1245315266
Provider Name (Legal Business Name): WILLIAM H BARSTOW MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 NW LARCH AVE SUITE A
REDMOND OR
97756-1323
US

IV. Provider business mailing address

213 NW LARCH AVE SUITE A
REDMOND OR
97756-1323
US

V. Phone/Fax

Practice location:
  • Phone: 541-526-6635
  • Fax: 541-526-6636
Mailing address:
  • Phone: 541-526-6635
  • Fax: 541-526-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD21764
License Number StateOR

VIII. Authorized Official

Name: DR. WILLIAM H BARSTOW IV
Title or Position: OWNER
Credential: MD
Phone: 541-526-6635