Provider Demographics
NPI:1841252558
Name:SEGAL, RICHARD J (MD PC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:SEGAL
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:875 OAK ST SE #5050
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3926
Mailing Address - Country:US
Mailing Address - Phone:503-588-5890
Mailing Address - Fax:503-370-8860
Practice Address - Street 1:875 OAK ST SE #5050
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3926
Practice Address - Country:US
Practice Address - Phone:503-588-5890
Practice Address - Fax:503-370-8860
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD17291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR036066Medicaid
OR036066Medicaid
ORR0000BKDHFMedicare PIN