Individual
ERIC J WATTENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3818 SW 21ST ST, REDMOND, OR 97756
(541) 548-2899
(541) 504-3781
Mailing address
PO BOX 4858, PORTLAND, OR 97208-4858
(541) 500-2500
(541) 500-2700
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD29323
OR
207Q00000X
Family Medicine Physician
6761572
ID
207Q00000X
Family Medicine Physician
A78764
CA
207Q00000X
Family Medicine Physician
Primary
MD29323
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00887743
MEDICARE RAILROAD
OR
05
—
500608820
—
OR
05
—
OOA787640
—
CA
Enumeration date
02/24/2006
Last updated
11/12/2024
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