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Vincent J Koletar

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NPI Number Detailed Information

Provider Information:

Name: Vincent J Koletar
Gender: M
Provider License Number If Given: MD18845

NPI Information:

NPI: 1891780342
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 4/23/2008

Provider Business Mailing Address:

Address: 2478 13TH ST SE
Salem, OR 97302
Phone Number: 5033622481
Fax Number: 5033717803

Provider Business Practice Location Address:

Address: 2478 13TH ST SE
Salem, OR 97302
Phone Number: 5033622481
Fax Number: 5033717803

Provider Taxonomy:

Primary: 208000000X
Secondary (if any):
State: OR

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