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NPI Code Detail

MEDICARE: LACEY ROYBAL D.O.

MEDICARE: LACEY ROYBAL D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianDO188595OR

General Provider Information

NPI Number : 1366977027
Entity Type Code : Individual
Provider Name (Legal Business Name) : LACEY ROYBAL D.O.
Provider Business Mailing Address
First Line : 3600 NW SAMARITAN DR
Second Line :
City : CORVALLIS
State : OR
Zip : 97330-3737
Country : US
Telephone Number : 541-768-4906
Fax Number :
Provider Business Practice Location Address
First Line : 1793 13TH ST SE
Second Line :
City : SALEM
State : OR
Zip : 97302-2541
Country : US
Telephone Number : 866-599-3376
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2017
Last Update Date : 11/10/2021

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Directions to “ LACEY ROYBAL D.O.” Practice Location

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