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General NPI Number Information
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NPI Number | 1396431797
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Entity Type | Organization
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Legal Business Name | REGAL HEALTHCARE, LLC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 14125 SW FARMINGTON RD STE B
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City | BEAVERTON
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State | OR
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Zip | 97005-2567
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Country | US
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Telephone | 503-519-9810
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Fax | 703-977-3863
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Provider Business Mailing Address
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Address Line | 17894 SW RICHARD CT
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City | ALOHA
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State | OR
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Zip | 97007-3913
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Country | US
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Telephone | 503-519-9810
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Fax | 703-977-3863
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MR. DAVID ALLEN MACKLEY
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Credential |
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Telephone | 503-519-9810
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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 |
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License Number State |
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