Healthcare Provider Details

I. General information

NPI: 1720348303
Provider Name (Legal Business Name): DAVID R MCWHORTER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 OAK ST SE
SALEM OR
97301-3905
US

IV. Provider business mailing address

3722 GALLOWAY ST S
SALEM OR
97302-6806
US

V. Phone/Fax

Practice location:
  • Phone: 503-814-0273
  • Fax:
Mailing address:
  • Phone: 217-474-9453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA202632
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: