Provider Demographics
NPI:1104055359
Name:DAVID L MACCABEE MD PC
Entity type:Organization
Organization Name:DAVID L MACCABEE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACCABEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-436-3880
Mailing Address - Street 1:514 STATE ST STE A
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-2074
Mailing Address - Country:US
Mailing Address - Phone:541-436-3880
Mailing Address - Fax:541-436-3881
Practice Address - Street 1:514 STATE ST STE A
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-2074
Practice Address - Country:US
Practice Address - Phone:541-436-3880
Practice Address - Fax:541-436-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23129208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty