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General NPI Number Information
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NPI Number | 1184821043
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Entity Type | Organization
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Legal Business Name | WILLAMETTE EAR NOSE & THROAT LLP
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 3099 RIVER RD S STE 150
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City | SALEM
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State | OR
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Zip | 97302-9754
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Country | US
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Telephone | 503-581-9445
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Fax | 503-485-2590
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Provider Business Mailing Address
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Address Line | 3099 RIVER RD S STE 150
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City | SALEM
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State | OR
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Zip | 97302-9754
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Country | US
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Telephone | 503-581-9445
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Fax | 503-485-2590
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. CLARK R THOMPSON
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Credential | M.D
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Telephone | 503-581-1567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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