Basic Information
| Provider Information | |||||||||
| NPI: | 1194828533 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIVAUDAIS | ||||||||
| FirstName: | WEST | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8899 CHAMPOEG RD NE | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971379746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036786088 | ||||||||
| FaxNumber: | 5036786087 | ||||||||
| Practice Location | |||||||||
| Address1: | SALEM HOSPITAL | ||||||||
| Address2: | 665 WINTER STREET SE | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973095014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035612448 | ||||||||
| FaxNumber: | 5035614759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | 12731 | OR | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1087394 | 05 | OR | MEDICAID |