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General NPI Number Information
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NPI Number | 1124234703
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Entity Type | Organization
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Legal Business Name | NORTHWEST FAMILY MEDICINE L.L.C.
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 605 WELCH ST
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City | SILVERTON
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State | OR
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Zip | 97381-1946
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Country | US
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Telephone | 503-873-6987
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Fax |
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Provider Business Mailing Address
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Address Line | 605 WELCH ST
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City | SILVERTON
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State | OR
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Zip | 97381-1946
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Country | US
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Telephone | 503-873-6987
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY ROY PETERS
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Credential | MD
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Telephone | 503-873-6987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | MD17287
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License Number State | OR
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