Provider Demographics
NPI:1316944572
Name:DE MORY, ANTHONY CHARLIES (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CHARLIES
Last Name:DE MORY
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 1:3355 RIVERBEND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8800
Mailing Address - Country:US
Mailing Address - Phone:541-485-6478
Mailing Address - Fax:541-868-9606
Practice Address - Street 1:3355 RIVERBEND DR STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8800
Practice Address - Country:US
Practice Address - Phone:541-485-6478
Practice Address - Fax:541-868-9606
Is Sole Proprietor?:No
Enumeration Date:2005-07-02
Last Update Date:2021-03-30
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-05-25
Provider Licenses
StateLicense IDTaxonomies
TXM4027207RN0300X
ORMD161523207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M2100OtherBSBC
TX181118401Medicaid
ORMD161523OtherSTATE LICENSE
CAG864980OtherLICENSE
TXE94396Medicare UPIN
TX8G7413Medicare PIN