Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD15726 | OR |
NPI | 1104990175 |
---|---|
Provider Name | Dr. Rick Dewitt Pittman |
First Address | Salem, OR 97302-2541 |
Second Address | Salem, OR 97302-2541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
049148 | (05) | OR |
A06246 | (02) | OR |