Provider Demographics
NPI:1871669465
Name:DOUGHMAN, DAVID JOHN
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOHN
Last Name:DOUGHMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6298 SW GRAND OAKS DR
Mailing Address - Street 2:H101
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-4496
Mailing Address - Country:US
Mailing Address - Phone:541-757-7269
Mailing Address - Fax:541-757-5465
Practice Address - Street 1:2211 NW PROFESSIONAL DR
Practice Address - Street 2:STE 100
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3891
Practice Address - Country:US
Practice Address - Phone:541-757-7269
Practice Address - Fax:541-757-7465
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0673225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR132052Medicare ID - Type Unspecified