Individual
VITALY LAYVANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2973 12TH ST SE, SALEM, OR 97302-3162
(503) 561-7100
Mailing address
2973 12TH ST SE, SALEM, OR 97302-3162
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
204341
OR
363A00000X
Physician Assistant
Primary
PA204341
OR
Other
Enumeration date
08/31/2021
Last updated
08/20/2025
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