Healthcare Provider Details

I. General information

NPI: 1700173218
Provider Name (Legal Business Name): JONAS H OLTMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST SUITE E-15
HERMISTON OR
97838-8605
US

IV. Provider business mailing address

600 NW 11TH ST SUITE E-15
HERMISTON OR
97838-8605
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-6434
  • Fax: 541-429-6613
Mailing address:
  • Phone: 541-567-6434
  • Fax: 541-429-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTL4128
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO166841
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: