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Dr. Nicolaas Willem De Wette

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NPI Number Detailed Information

Provider Information:

Name: Dr. Nicolaas Willem De Wette
Gender: M
Provider License Number If Given: MD23344

NPI Information:

NPI: 1689677692
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 12/22/2011

Provider Business Mailing Address:

Address: 265 N BROADWAY ST
Portland, OR 97227
Phone Number: 5032801223
Fax Number: 5035285252

Provider Business Practice Location Address:

Address: 265 N BROADWAY ST
Portland, OR 97227
Phone Number: 5032801223
Fax Number: 5035285252

Provider Taxonomy:

Primary: 2085R0001X
Secondary (if any):
State: OR

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