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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 |