Healthcare Provider Details

I. General information

NPI: 1720147622
Provider Name (Legal Business Name): DAVID OWSHALIMPUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MAIN ST STE 400
VANCOUVER WA
98660-2963
US

IV. Provider business mailing address

PO BOX 211699
EAGAN MN
55121-3699
US

V. Phone/Fax

Practice location:
  • Phone: 866-849-0692
  • Fax:
Mailing address:
  • Phone: 866-849-0692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60436625
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23196
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number76838
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberCDR.0005046
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35C.002665
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMED-PHYS-LIC-148446
License Number StateMT
# 7
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number74675
License Number StateTN
# 8
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number23196
License Number StateNE
# 9
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036174406
License Number StateIL
# 10
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME174103
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD.50919
License Number StateAL
# 12
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01096148A
License Number StateIN
# 13
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD-25332
License Number StateHI
# 14
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number34986
License Number StateMS
# 15
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number23196
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: