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General NPI Number Information
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NPI Number | 1225217995
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Entity Type | Organization
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Legal Business Name | MID VALLEY FAMILY PHYSICIANS
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 550 DIETZ AVE NE
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City | KEIZER
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State | OR
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Zip | 97303-4615
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Country | US
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Telephone | 503-393-0540
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Fax | 503-393-3695
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Provider Business Mailing Address
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Address Line | 550 DIETZ AVE NE
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City | KEIZER
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State | OR
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Zip | 97303-4615
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Country | US
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Telephone | 503-393-0540
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Fax | 503-393-3695
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | RONALD M PALM
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Credential | DO
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Telephone | 503-393-0540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D025292
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D025302
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License Number State | OR
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