Healthcare Provider Details

I. General information

NPI: 1801800149
Provider Name (Legal Business Name): PHYSICIANS BUILDING GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 COMMERCIAL ST SE
SALEM OR
97302-4204
US

IV. Provider business mailing address

1234 COMMERCIAL ST SE
SALEM OR
97302-4204
US

V. Phone/Fax

Practice location:
  • Phone: 503-362-9334
  • Fax: 503-362-8016
Mailing address:
  • Phone: 503-362-9334
  • Fax: 503-362-8016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number StateOR

VIII. Authorized Official

Name: MRS. RACHAEL K LAMB
Title or Position: ADMINISTRATOR
Credential:
Phone: 503-362-9335