Provider Demographics
NPI:1093814642
Name:WEIRICH, SAMUEL DRAPER (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DRAPER
Last Name:WEIRICH
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 1:15920 OSWEGO SHORE CT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3617
Mailing Address - Country:US
Mailing Address - Phone:503-699-0438
Mailing Address - Fax:503-699-0736
Practice Address - Street 1:203 SE PARK PLAZA DR
Practice Address - Street 2:SUITE 140
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5886
Practice Address - Country:US
Practice Address - Phone:360-449-7039
Practice Address - Fax:960-449-7034
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19018207XS0106X
WAMD00027264207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR061890Medicaid
OR061890Medicaid
ORF42439Medicare UPIN