Provider Demographics
NPI:1881819563
Name:RUTHVEN, DARYL SPENCER (MD)
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:SPENCER
Last Name:RUTHVEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6193 81ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-9109
Mailing Address - Country:US
Mailing Address - Phone:503-749-3486
Mailing Address - Fax:
Practice Address - Street 1:2575 CENTER ST NE
Practice Address - Street 2:COUNSELING & TREATMENT SERVICES
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97310-0001
Practice Address - Country:US
Practice Address - Phone:503-378-8373
Practice Address - Fax:503-378-5118
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD156862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry