Individual
JIMMY WIMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2011 4TH ST, LA GRANDE, OR 97850-2511
(541) 963-4139
Mailing address
PO BOX 1893, CORVALLIS, OR 97339-1893
Taxonomy
Speciality
Code
Description
License number
State
2471S1302X
Sonography Radiologic Technologist
Primary
OBMI901520
OR
Other
Enumeration date
12/23/2013
Last updated
12/24/2013
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