Healthcare Provider Details

I. General information

NPI: 1821021114
Provider Name (Legal Business Name): KATIE HOUTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W C ST
SILVERTON OR
97381-1458
US

IV. Provider business mailing address

335 FAIRVIEW ST
SILVERTON OR
97381-1916
US

V. Phone/Fax

Practice location:
  • Phone: 503-874-4747
  • Fax: 503-874-4638
Mailing address:
  • Phone: 503-873-8686
  • Fax: 503-873-8689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2006018519
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21815
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: