Healthcare Provider Details

I. General information

NPI: 1740352087
Provider Name (Legal Business Name): CRAVEN & WRIGHT MDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 10TH AVE
STAYTON OR
97383-1311
US

IV. Provider business mailing address

PO BOX 806
CORVALLIS OR
97339-0806
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-2175
  • Fax:
Mailing address:
  • Phone: 541-758-5047
  • Fax: 541-758-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateOR

VIII. Authorized Official

Name: DAVID J WRIGHT
Title or Position: PRESIDENT
Credential: MD
Phone: 503-288-6021