NPI Code Detail JSON Logo

1619080454 NPI number — DAN A BEAVER DO

NPI Number: 1619080454
Health Care Provider/Practitioner: DAN A BEAVER DO

Information about “1619080454” NPI (DAN A BEAVER DO) exists in 1619080454 in HTML format HTML  |  1619080454 in plain Text format TXT  |  1619080454 in PDF (Portable Document Format) PDF  |  1619080454 in an XML format XML  formats.

NPI Number : 1619080454 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619080454",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BEAVER",
    "FirstName": "DAN",
    "MiddleName": "A",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BEAVER",
    "OtherFirstName": "DANIEL",
    "OtherMiddleName": "A",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "DO",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "3400 DEER LAKE CT SE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SALEM",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97317",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-588-6919",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5125 SKYLINE RD S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SALEM",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97306-9427",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-361-5400",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/16/2006",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": "OR DO16464",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.