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General NPI Number Information
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NPI Number | 1639176613
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Entity Type | Individual
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Provider Name | KATHERINE WILLIAMS OMER M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2005
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 1620 E 12TH ST STE 200
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City | THE DALLES
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State | OR
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Zip | 97058-3213
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Country | US
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Telephone | 541-296-9151
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Fax | 541-296-9156
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Provider Business Mailing Address
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Address Line | PO BOX 1520
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City | THE DALLES
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State | OR
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Zip | 97058-8003
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Country | US
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Telephone | 541-296-7668
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 36687
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD157435
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License Number State | OR
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