Healthcare Provider Details

I. General information

NPI: 1295042976
Provider Name (Legal Business Name): DEREK RILEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1377 N 10TH AVE
STAYTON OR
97383-2037
US

IV. Provider business mailing address

1377 N 10TH AVE
STAYTON OR
97383-2037
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-8470
  • Fax: 503-769-9860
Mailing address:
  • Phone: 503-769-8470
  • Fax: 503-769-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDO217386
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: