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Physicians Internal Medicine

Provider NPI: 1174728968

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
1825 E 19TH ST  THE DALLES, OR 97058 US
Tel: 541-506-6530  Fax: 541-506-6531

Business Mailing Address:
1825 E 19TH ST  THE DALLES, OR 97058-3365 US
Tel: 541-506-6530  Fax: 541-506-6531

NPI Information:
NPI: 1174728968
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Internal Medicine
Internal Medicine
Nuclear Medicine
Internal Medicine

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207RC0000X





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