Provider Demographics
NPI:1386641231
Name:PEFFLEY, RICHARD II (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:PEFFLEY
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MILLER ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4248
Mailing Address - Country:US
Mailing Address - Phone:503-370-8784
Mailing Address - Fax:503-362-4017
Practice Address - Street 1:350 MILLER ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4248
Practice Address - Country:US
Practice Address - Phone:503-370-8784
Practice Address - Fax:503-362-4017
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-09
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
ORDP00219213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR065941Medicaid
OR9535341630000OtherTRICARE NORTHWEST PIN
OR054437000OtherREGENCE BLUECROSS BLUESHI
OR953534163OtherODS PIN
ORV242001OtherPACIFIC SOURCE PIN
OR9535341630000EOtherMAILHANDLERS PIN
ORDP4Z290OtherHEALTH NET PIN
OR953534163002OtherUHC PIN
OR305976OtherPROVIDENCE HEALTH PIN
OR480018560OtherRAILROAD RETIREMENT PIN
OR0001OtherWPS TRICARE CLAIMS PIN
OR1148590001OtherDMERC PIN
OR480018560OtherPALMENTO GBA
OR480018560OtherPALMENTO GBA
ORR0000SGBLWMedicare PIN