Provider Demographics
NPI:1396875571
Name:LOEWEN, DAVID T
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:T
Last Name:LOEWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1535
Mailing Address - Country:US
Mailing Address - Phone:503-233-6141
Mailing Address - Fax:503-233-2889
Practice Address - Street 1:3066 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1396
Practice Address - Country:US
Practice Address - Phone:503-315-2055
Practice Address - Fax:503-315-2057
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-290843237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR212936Medicaid
2432417000OtherFEDERAL WORKERS COMP