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General NPI Number Information
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NPI Number | 1083932917
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Entity Type | Organization
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Legal Business Name | QUIMPER FAMILY MEDICINE PC
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Dates
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Enumeration Date | 05/17/2010
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Last Update Date | 05/17/2010
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Provider Practice Location Address
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Address Line | 2120 LAWRENCE ST
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-7925
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Country | US
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Telephone | 360-385-3826
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Fax | 360-385-3937
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Provider Business Mailing Address
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Address Line | 2120 LAWRENCE ST
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City | PORT TOWNSEND
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State | WA
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Zip | 98368-7925
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Country | US
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Telephone | 360-385-3826
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Fax | 360-385-3937
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Authorized Official
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Title or Position | PRESIDENT
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Name | KATHERINE TEMPLE OTTAWAY
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Credential | MD
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Telephone | 360-385-3826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00038123
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License Number State | WA
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