1912153024 NPI number — MR. HENRY STEVE DUTCHOVER JR. P.T.

Table of content: MR. HENRY STEVE DUTCHOVER JR. P.T. (NPI 1912153024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912153024 NPI number — MR. HENRY STEVE DUTCHOVER JR. P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUTCHOVER
Provider First Name:
HENRY
Provider Middle Name:
STEVE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUTCHOVER
Provider Other First Name:
HANK
Provider Other Middle Name:
STEVE
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
P.T,
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1912153024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5226 WALES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUGENE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97402-7520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-510-2521
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 ALEXANDER LOOP
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:
97401-6524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-345-6199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2008

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: 225100000X , with the licence number:  4364 , 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)





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