1225036189 NPI number — MICHAEL C. DUVAL DMD

Table of content: MS. PAMELA SUE HAMMONS (NPI 1407236805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225036189 NPI number — MICHAEL C. DUVAL DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUVAL
Provider First Name:
MICHAEL
Provider Middle Name:
C.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225036189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/25/2006
NPI Reactivation Date:
04/14/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2640 FRONTAGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REEDSPORT
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97467-1813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-271-4858
Provider Business Mailing Address Fax Number:
541-271-4859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2640 FRONTAGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REEDSPORT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97467-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-271-4858
Provider Business Practice Location Address Fax Number:
541-271-4859
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D05541 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 078758 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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