Individual
DR. TIMOTHY EDELBLUTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
665 WINTER ST SE, SALEM, OR 97301-3919
(503) 561-5634
Mailing address
PO BOX 2505, SALEM, OR 97308-2505
(888) 828-3198
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD20678
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
150406
MARION POLK CHP
—
05
—
150406
—
OR
05
—
8363673
—
WA
01
—
A045
CHAMPUS
—
01
—
G57684
GROUP HEALTH
—
05
—
XPY198713
—
CA
Enumeration date
08/16/2006
Last updated
12/04/2007
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