Provider Demographics
NPI:1255470076
Name:OLWYN K DAVIES MD PC
Entity Type:Organization
Organization Name:OLWYN K DAVIES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLWYN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-873-5331
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:410 WELCH STREET
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381
Mailing Address - Country:US
Mailing Address - Phone:503-873-5331
Mailing Address - Fax:503-873-8513
Practice Address - Street 1:410 WELCH STREET
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381
Practice Address - Country:US
Practice Address - Phone:503-873-5331
Practice Address - Fax:503-873-8513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD05350208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR050658Medicaid
OR050658Medicaid
OR050658Medicaid
ORR0000BBVSNMedicare PIN