Provider Demographics
NPI:1114018033
Name:MACCABEE, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:MACCABEE
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 1:514 STATE ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-2074
Mailing Address - Country:US
Mailing Address - Phone:541-436-3880
Mailing Address - Fax:541-436-3881
Practice Address - Street 1:514 STATE ST STE A
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2074
Practice Address - Country:US
Practice Address - Phone:541-436-3880
Practice Address - Fax:541-436-3881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23129208600000X
CAC53885208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB234772OtherMEDICARE ID