Healthcare Provider Details

I. General information

NPI: 1356304042
Provider Name (Legal Business Name): GRETCHEN L HITTLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14829 NE COUNTRYSIDE DR
AURORA OR
97002-9503
US

IV. Provider business mailing address

14829 NE COUNTRYSIDE DR
AURORA OR
97002-9503
US

V. Phone/Fax

Practice location:
  • Phone: 971-506-1265
  • Fax:
Mailing address:
  • Phone: 971-506-1265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD18300
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: