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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 |
