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Individual

EDWARD J OTTENHEIMER III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1813 W HARVARD AVE, STE 436, ROSEBURG, OR 97471-8705
(541) 673-0496
(541) 673-5794
Mailing address
1813 W HARVARD AVE, STE 436, ROSEBURG, OR 97471-8705
(541) 673-0496
(541) 673-5794

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
MD20394
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
085790
OR
Enumeration date
10/02/2006
Last updated
01/11/2020
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