Provider Demographics
NPI:1275634792
Name:SALEM GASTROENTEROLOGY CONSULTANTS, PC
Entity Type:Organization
Organization Name:SALEM GASTROENTEROLOGY CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-561-4043
Mailing Address - Street 1:875 OAK ST SE
Mailing Address - Street 2:SUITE 3010
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3975
Mailing Address - Country:US
Mailing Address - Phone:503-399-7520
Mailing Address - Fax:503-362-7344
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:SUITE 3010
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3975
Practice Address - Country:US
Practice Address - Phone:503-399-7520
Practice Address - Fax:503-362-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027980Medicaid
OR0000WFBYVMedicare ID - Type Unspecified