Provider Demographics
NPI:1194828533
Name:LIVAUDAIS, WEST JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WEST
Middle Name:
Last Name:LIVAUDAIS
Suffix:JR
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 1:8899 CHAMPOEG RD NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:OR
Mailing Address - Zip Code:97137-9746
Mailing Address - Country:US
Mailing Address - Phone:503-678-6088
Mailing Address - Fax:503-678-6087
Practice Address - Street 1:SALEM HOSPITAL
Practice Address - Street 2:665 WINTER STREET SE
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97309-5014
Practice Address - Country:US
Practice Address - Phone:503-561-2448
Practice Address - Fax:503-561-4759
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR127312086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1087394Medicaid
OR1087394Medicaid
ORR115552Medicare ID - Type Unspecified