Healthcare Provider Details

I. General information

NPI: 1972998722
Provider Name (Legal Business Name): DEREK J MCFAUL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HAYDEN BRIDGE WAY
SPRINGFIELD OR
97477-1347
US

IV. Provider business mailing address

1 HAYDEN BRIDGE WAY
SPRINGFIELD OR
97477-1347
US

V. Phone/Fax

Practice location:
  • Phone: 541-868-9430
  • Fax: 541-868-9450
Mailing address:
  • Phone: 541-868-9430
  • Fax: 541-868-9450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDO203644
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: