Provider Demographics
NPI:1023013620
Name:HALBUR, RICHARD B (PAC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:B
Last Name:HALBUR
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:157 SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:OR
Practice Address - Zip Code:97327-0160
Practice Address - Country:US
Practice Address - Phone:541-451-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA165019363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical