Healthcare Provider Details

I. General information

NPI: 1114337409
Provider Name (Legal Business Name): R. SCOTT BABE, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2264 MCGILCHRIST ST SE STE 100
SALEM OR
97302-1008
US

IV. Provider business mailing address

2264 MCGILCHRIST ST SE STE 100
SALEM OR
97302-1008
US

V. Phone/Fax

Practice location:
  • Phone: 503-581-7700
  • Fax: 503-581-7799
Mailing address:
  • Phone: 503-581-7700
  • Fax: 503-581-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberMD21972
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberMD21972
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD21972
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO161429
License Number StateOR

VIII. Authorized Official

Name: DR. RODNEY SCOTT BABE
Title or Position: OWNER
Credential: MD
Phone: 503-581-7700