Provider Demographics
NPI:1306727409
Name:LAVERING, RICHARD J
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:LAVERING
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 1:2296 GALICE RD
Mailing Address - Street 2:
Mailing Address - City:MERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97532-8792
Mailing Address - Country:US
Mailing Address - Phone:541-660-4733
Mailing Address - Fax:
Practice Address - Street 1:2296 GALICE RD
Practice Address - Street 2:
Practice Address - City:MERLIN
Practice Address - State:OR
Practice Address - Zip Code:97532-8792
Practice Address - Country:US
Practice Address - Phone:541-660-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program