Healthcare Provider Details

I. General information

NPI: 1316277445
Provider Name (Legal Business Name): GEOFFREY C. FLETCHER N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 N 8TH ST
PHILOMATH OR
97370-9316
US

IV. Provider business mailing address

PO BOX 1031
PHILOMATH OR
97370-1031
US

V. Phone/Fax

Practice location:
  • Phone: 541-929-6788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1720
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1720
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerOREGON BOARD OF NATUROPATHIC MEDICINE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: