1437650405 NPI number — ANGELA R DARBY

Table of content: ANGELA R DARBY (NPI 1437650405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437650405 NPI number — ANGELA R DARBY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DARBY
Provider First Name:
ANGELA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1437650405
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3587 HEATHROW WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97504-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-858-8170
Provider Business Mailing Address Fax Number:
541-858-8167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 CENTENNIAL LOOP STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUGENE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97401-2443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-505-8426
Provider Business Practice Location Address Fax Number:
541-515-6938
Provider Enumeration Date:
02/26/2018

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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