Healthcare Provider Details

I. General information

NPI: 1326299843
Provider Name (Legal Business Name): DOUGLAS SCOTT HAMBLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/19/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 WELCH ST
SILVERTON OR
97381-1946
US

IV. Provider business mailing address

605 WELCH ST
SILVERTON OR
97381-1946
US

V. Phone/Fax

Practice location:
  • Phone: 503-782-1975
  • Fax: 503-343-6232
Mailing address:
  • Phone: 503-782-1975
  • Fax: 503-343-6232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number104220
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD167314
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME104220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: