Provider Demographics
NPI:1083784896
Name:DEVORSS, JAMES ERNEST (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ERNEST
Last Name:DEVORSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1687 SKY TERRACE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9557
Mailing Address - Country:US
Mailing Address - Phone:503-399-0811
Mailing Address - Fax:
Practice Address - Street 1:665 WINTER ST SE
Practice Address - Street 2:SALEM HOSPITAL
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3919
Practice Address - Country:US
Practice Address - Phone:503-399-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08610207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR047712Medicaid
OR047712Medicaid
0000BHDGMMedicare ID - Type Unspecified