Healthcare Provider Details

I. General information

NPI: 1902968829
Provider Name (Legal Business Name): DENISE G WAUGH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 G ST
SPRINGFIELD OR
97477-4112
US

IV. Provider business mailing address

PO BOX 11840
WESTMINSTER CA
92685-1840
US

V. Phone/Fax

Practice location:
  • Phone: 541-726-4400
  • Fax:
Mailing address:
  • Phone: 800-511-4875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE G WAUGH
Title or Position: PRESIDENT
Credential: MD
Phone: 541-726-4400