Provider Demographics
NPI:1386968303
Name:MCEWEN, RICHARD ALDEN III (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALDEN
Last Name:MCEWEN
Suffix:III
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 1:227 W 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3008
Mailing Address - Country:US
Mailing Address - Phone:541-275-2864
Mailing Address - Fax:
Practice Address - Street 1:227 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3008
Practice Address - Country:US
Practice Address - Phone:504-453-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206705207P00000X, 207Q00000X
ORMD193145207P00000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2105361Medicaid