Provider Demographics
NPI:1417986761
Name:DEHAAS, DAVID R JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:DEHAAS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PEACEHEALTH SURGICAL SPECIALITIES
Mailing Address - Street 2:3355 RIVERBEND DR., SUITE 300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477
Mailing Address - Country:US
Mailing Address - Phone:541-222-8333
Mailing Address - Fax:541-222-8320
Practice Address - Street 1:PEACEHEALTH SURGICAL SPECIALITIES
Practice Address - Street 2:3355 RIVERBEND DR., SUITE 300
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477
Practice Address - Country:US
Practice Address - Phone:541-222-8333
Practice Address - Fax:541-222-8320
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2024-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD19160208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR069252Medicaid
ORR0000WFBLLEMedicare PIN