Healthcare Provider Details

I. General information

NPI: 1740212232
Provider Name (Legal Business Name): DEBORAH J DOTTERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 RIVERBEND DR STE 210
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

PO BOX 70368
EUGENE OR
97401-0120
US

V. Phone/Fax

Practice location:
  • Phone: 541-465-3300
  • Fax: 541-683-1709
Mailing address:
  • Phone: 541-465-3300
  • Fax: 541-683-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD16053
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: