Dallas Family Medicine LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD13699 Issued in OR

Legal business name

DALLAS FAMILY MEDICINE LLC

Practice address

641 SE Miller Ave
Dallas, OR 97338-2634

Phone

(503) 623-2345

Fax

(503) 623-6071

NPI assigned

Aug 17, 2005

Reactivated

Jan 14, 2008

Last updated

Oct 22, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Christopher W Edwardson, MD

Title

Sole Member

Phone

(503) 623-2345

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1942292891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "641 SE MILLER AVE",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973382634",
            "telephone_number": "503-623-2345",
            "fax_number": "503-623-6071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "641 SE MILLER AVE",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973382634",
            "telephone_number": "503-623-2345",
            "fax_number": "503-623-6071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALLAS FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-17",
        "last_updated": "2012-10-22",
        "deactivation_date": "2005-08-30",
        "reactivation_date": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "EDWARDSON",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "503-623-2345",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "OR",
            "license": "MD13699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• County of Polk (Polk County Mental Health)
• County of Polk
• Cassi June Ann Crawford
• Jessica Cecilia Cromwell
• Inge Daeschel, R.D., L.D.
• Dallas Health Care Center L L C (Dallas Retirement Village Health Center)
• Dallas Mennonite Retirement Community, Inc.
• Dallas Oregon Emergency Physicians LLC
• Dallas School District
• Victoria Roth Darling, MS

• Specialist in Dallas, OR
• Providers in Dallas, OR by specialty
• Specialist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; 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.