Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD11689 | OR |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD11689 | OR |
NPI | 1336181106 |
---|---|
Provider Name | Dr. Kenneth L. Orwick |
First Address | Lebanon, OR 97355-4229 |
Second Address | Lebanon, OR 97355-4229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C91445 | (02) | OR |