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NPI Code Detail

MEDICARE: DR. ETHAN W. GAUMOND MD

MEDICARE: DR. ETHAN W. GAUMOND MD
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
1207L00000XAnesthesiology PhysicianMD25160OR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00203043OTHERORRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487629184
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ETHAN W. GAUMOND MD
Provider Business Mailing Address
First Line : PO BOX 1189
Second Line :
City : CORVALLIS
State : OR
Zip : 97339-1189
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3600 NW SAMARITAN DR
Second Line :
City : CORVALLIS
State : OR
Zip : 97330-5472
Country : US
Telephone Number : 541-768-5111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2006
Last Update Date : 12/08/2025

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Directions to “ DR. ETHAN W. GAUMOND MD” Practice Location

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