Individual
DR. THEODORE H. DE LOOZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
707 SW WASHINGTON ST, SUITE 700, PORTLAND, OR 97205-3536
(503) 299-9906
(503) 225-9002
Mailing address
PO BOX 2040, PORTLAND, OR 97208-2040
(503) 299-9906
(503) 225-9002
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD12883
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041090
—
OR
01
—
050033645
RR MEDICARE
OR
05
—
1073063
—
WA
05
—
1730154410
—
ID
05
—
MD641OR
—
AK
Enumeration date
02/17/2006
Last updated
09/09/2013
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