Provider Demographics
NPI:1508921354
Name:MAGILKE, DAVID DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DEAN
Last Name:MAGILKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9427 SW BARNES ROAD
Mailing Address - Street 2:SUITE 394
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-3371
Mailing Address - Country:US
Mailing Address - Phone:503-297-6511
Mailing Address - Fax:503-297-5231
Practice Address - Street 1:9427 SW BARNES RD STE 394
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6616
Practice Address - Country:US
Practice Address - Phone:503-297-6511
Practice Address - Fax:503-297-5231
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19765207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR079350Medicaid
ORG24780Medicare UPIN
OR079350Medicaid