Provider Demographics
NPI:1215142294
Name:DRAVIS, DONALD (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:DRAVIS
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:COUNSELING AND TREATMENT SERVICES
Mailing Address - Street 2:2575 CENTER STREET NE
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97310-0001
Mailing Address - Country:US
Mailing Address - Phone:503-378-2446
Mailing Address - Fax:503-378-3228
Practice Address - Street 1:OREGON STATE PENITENTIARY
Practice Address - Street 2:2605 STATE STREET
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97310-0001
Practice Address - Country:US
Practice Address - Phone:503-378-2446
Practice Address - Fax:503-378-3228
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD216452084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry