Healthcare Provider Details

I. General information

NPI: 1376686659
Provider Name (Legal Business Name): JOSEPH PAUL WHITSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 MT HOOD AVE SILVERTON HOSPITAL IMMEDIATE CARE
WOODBURN OR
97071
US

IV. Provider business mailing address

1475 MT HOOD AVE SILVERTON HOSPITAL IMMEDIATE CARE
WOODBURN OR
97071
US

V. Phone/Fax

Practice location:
  • Phone: 971-983-5360
  • Fax: 971-983-5370
Mailing address:
  • Phone: 971-983-5360
  • Fax: 971-983-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO24133
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: