Organization
DEEP ROOTS FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE GONZALES ND (OWNER)
(541) 602-7096
Entity
Organization
Contact information
Practice address
605 UNION ST NE, SALEM, OR 97301-2462
(971) 207-3680
(503) 339-9585
Mailing address
605 UNION ST NE, SALEM, OR 97301-2462
(971) 207-3680
(503) 339-9585
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
C3986
OR
175F00000X
Naturopath
00960
OR
175F00000X
Naturopath
Primary
1781
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083864029
NPPES
OR
01
—
1184647398
NPPES
OR
01
—
1902115215
NPPES
OR
Enumeration date
06/24/2017
Last updated
07/21/2022
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