Individual
KENT W DAUTERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
520 MEDICAL CENTER DR, SUITE 200, MEDFORD, OR 97504-4314
(541) 282-6600
(541) 282-6601
Mailing address
520 MEDICAL CENTER DR, SUITE 200, MEDFORD, OR 97504-4314
(541) 282-6606
(541) 282-6601
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD24049
OR
207RI0011X
Interventional Cardiology Physician
Primary
MD24049
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226915
—
OR
05
—
227698
—
OR
Enumeration date
10/10/2005
Last updated
01/06/2015
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