Individual
LOREN MICAHEL TETZLAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
400 HICKORY ST NW STE 200, ALBANY, OR 97321-1700
(541) 812-5800
Mailing address
PO BOX 1188, CORVALLIS, OR 97339-1188
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA195275
OR
Other
Enumeration date
09/27/2019
Last updated
11/03/2020
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