Provider Demographics
NPI:1588647317
Name:DAVIES, ROBERT R (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:DAVIES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 SKYLINE VILLAGE LOOP S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9490
Mailing Address - Country:US
Mailing Address - Phone:503-391-1110
Mailing Address - Fax:503-370-4237
Practice Address - Street 1:5050 SKYLINE VILLAGE LOOP S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9490
Practice Address - Country:US
Practice Address - Phone:503-391-1110
Practice Address - Fax:503-370-4237
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO13635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR171504Medicaid
107684Medicare ID - Type Unspecified
OR171504Medicaid