Provider Demographics
NPI:1871090209
Name:PRICE, JOHN DAVID
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:PRICE
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 1:16085 AIRLIE RD
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH
Mailing Address - State:OR
Mailing Address - Zip Code:97361-9523
Mailing Address - Country:US
Mailing Address - Phone:503-831-4855
Mailing Address - Fax:
Practice Address - Street 1:180 WARREN ST S
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-2137
Practice Address - Country:US
Practice Address - Phone:503-838-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator