# STAYTON FAMILY PRACTICE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912130915
- **Authorized official:** DR. LANCE B LARGE MD (OWNER)
- **Authorized official phone:** (503) 400-6140

## Contact information

- **Practice address:** 1881 W WASHINGTON ST, STAYTON, OR 97383-9511
- **Practice address phone:** (503) 400-6140
- **Practice address fax:** (503) 769-3797
- **Mailing address:** 1881 W WASHINGTON ST, STAYTON, OR 97383-9511
- **Mailing address phone:** (503) 400-6140
- **Mailing address fax:** (503) 769-3797

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/25/2009
- **Last updated:** 06/15/2022