Organization
THOMAS D. UTTERBACK, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS D UTTERBACK M.D. (PRESIDENT)
(503) 684-1830
Entity
Organization
Contact information
Practice address
8051 S LONE ELDER RD, CANBY, OR 97013-9127
(503) 684-1830
(503) 684-1830
Mailing address
8051 S LONE ELDER RD, CANBY, OR 97013-9127
(503) 684-1830
(503) 684-1830
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ORMD07612
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100000004607
REGENCE BCBSO
OR
05
—
240804
—
OR
01
—
C93989000003
PROVIDENCE HEALTH PLAN
OR
Enumeration date
08/08/2014
Last updated
08/08/2014
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