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Individual

JOHNNY DEBLOCK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
665 WINTER ST SE, SALEM, OR 97301-3919
(503) 561-5200
Mailing address
1413 CEDARCREST CT S, SALEM, OR 97306-2273

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO23311
OR

Other

Enumeration date
03/09/2007
Last updated
07/08/2007
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