Provider Demographics
NPI:1467559286
Name:TROY RICHEY MD PC
Entity Type:Organization
Organization Name:TROY RICHEY MD PC
Other - Org Name:WILLAMETTE VALLEY DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-344-4168
Mailing Address - Street 1:360 S GARDEN WAY STE 230
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8187
Mailing Address - Country:US
Mailing Address - Phone:541-344-4138
Mailing Address - Fax:458-201-8510
Practice Address - Street 1:360 S GARDEN WAY STE 230
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8187
Practice Address - Country:US
Practice Address - Phone:541-747-6159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20398207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR831297000OtherBCBS
R142505Medicare PIN
OR831297000OtherBCBS