NPIMap

Organization Active NPI

Dean McNabb DPM LLC

Doing business as Pacific NW Foot and Ankle

  • Foot & Ankle Surgery Podiatrist
  • McMinnville, OR
National Provider Identifier
1063690527
Registry record updated Jun 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
DP00344 Issued in OR
Legal business name
DEAN MCNABB DPM LLC
Doing business as
Pacific NW Foot and Ankle
Practice address
851 NE Baker St
Suite 4
McMinnville, OR 97128-4991
Phone
(503) 434-5222
Fax
(877) 878-1984
NPI assigned
Feb 7, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Earl Dean McNabb, DPM
Title
Owner
Phone
(503) 390-0959

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X DP00344 OR Primary

Addresses

Primary practice location

851 NE Baker St
Suite 4
McMinnville, OR 97128-4991

Mailing address

PO Box 20367
Keizer, OR 97307-0367
Phone (503) 390-0959

Other identifiers 2

IdentifierTypeStateIssuer
182958MedicaidOR
118186OtherORMEDICARE MAC

Other names 1

  • PACIFIC NW FOOT AND ANKLE Doing business as

National Provider Directory

National Provider Directory

Locations

3625 River Rd N
Ste 275
Keizer, OR 97303
Phone (503) 390-0959

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371168000000",
    "number": "1063690527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20367",
            "city": "KEIZER",
            "state": "OR",
            "postal_code": "973070367",
            "telephone_number": "503-390-0959",
            "fax_number": "877-878-1984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 NE BAKER ST",
            "address_2": "SUITE 4",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "971284991",
            "telephone_number": "503-434-5222",
            "fax_number": "877-878-1984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEAN MCNABB DPM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-07",
        "last_updated": "2013-06-14",
        "status": "A",
        "authorized_official_last_name": "MCNABB",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-390-0959",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OR",
            "license": "DP00344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182958",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE MAC",
            "identifier": "118186",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PACIFIC NW FOOT AND ANKLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McMinnville, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.