Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2082S0105X | Plastic Hand Surgeon | MD23577 | AZ |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD23577 | OR |
NPI | 1699772277 |
---|---|
Provider Name | Richard C. Havard |
First Address | Corvallis, OR 97339-1189 |
Second Address | Corvallis, OR 97330-1485 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 11/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
287015 | (05) | OR |
E87076 | (02) |