Provider Demographics
NPI:1164788766
Name:CHANCE, WILLIAM WARREN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WARREN
Last Name:CHANCE
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:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-0391
Mailing Address - Country:US
Mailing Address - Phone:503-814-5294
Mailing Address - Fax:503-814-0457
Practice Address - Street 1:875 OAK ST SE STE 1080
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3977
Practice Address - Country:US
Practice Address - Phone:503-561-5294
Practice Address - Fax:503-814-0457
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD 1811422085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500722681Medicaid
ORMD181142OtherOR MEDICAL LICENSE
ORR194126OtherMEDICARE PTAN OREGON
ORR194126OtherMEDICARE PTAN OREGON