Healthcare Provider Details

I. General information

NPI: 1841275393
Provider Name (Legal Business Name): DOCTORS CLINIC LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 SKYLINE VILLAGE LOOP S
SALEM OR
97306-9490
US

IV. Provider business mailing address

5050 SKYLINE VILLAGE LOOP S
SALEM OR
97306-9490
US

V. Phone/Fax

Practice location:
  • Phone: 503-391-1110
  • Fax: 503-370-4237
Mailing address:
  • Phone: 503-391-1110
  • Fax: 503-370-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES T MCKEON
Title or Position: ADMINISTRATOR
Credential:
Phone: 503-391-1110