Healthcare Provider Details

I. General information

NPI: 1912092339
Provider Name (Legal Business Name): DIANE LOUISE BOTELER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 DEYE LANE ORCAS MEDICAL CENTER, PLLC
EASTSOUND WA
98245-1269
US

IV. Provider business mailing address

PO BOX 1269 ORCAS MEDICAL CENTER PLLC
EASTSOUND WA
98245-1269
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-2561
  • Fax: 360-376-5183
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00027712
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: