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General NPI Number Information
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NPI Number | 1821073701
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Entity Type | Individual
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Provider Name | MICHAEL LOWRIE PENDLETON M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 12/22/2017
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Provider Practice Location Address
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Address Line | 849 PACIFIC AVE
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City | HOOD RIVER
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State | OR
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Zip | 97031-1956
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Country | US
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Telephone | 541-308-8370
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Fax | 541-308-0754
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Provider Business Mailing Address
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Address Line | 1040 WEBBER ST
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City | THE DALLES
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State | OR
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Zip | 97058-3749
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Country | US
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Telephone | 541-298-4160
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 22825
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD14783
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License Number State | OR
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