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Individual

DAVID LAWRENCE FEDEROFF

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
157 SPAULDING AVE, BROWNSVILLE, OR 97327
(541) 451-6940
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA195905
OR
363AM0700X
Medical Physician Assistant
56220
CA
363AM0700X
Medical Physician Assistant
PA195905
OR

Other

Enumeration date
12/17/2018
Last updated
08/28/2025
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