Provider Demographics
NPI:1184672651
Name:DAYTON, BETH (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:DAYTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 OAK ST SE
Mailing Address - Street 2:#4010
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3907
Mailing Address - Country:US
Mailing Address - Phone:503-364-6843
Mailing Address - Fax:503-585-5273
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:#4010
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3907
Practice Address - Country:US
Practice Address - Phone:503-364-6843
Practice Address - Fax:503-585-5273
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17693208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR045802Medicaid
OR045802Medicaid
F27511Medicare UPIN