Individual
DR. LAURIE DUTKIEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O
Contact information
Practice address
965 ELLENDALE DR, MEDFORD, OR 97504-8215
(541) 734-3430
(541) 734-3638
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 734-3430
(541) 734-3638
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DO153852
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500637941
—
OR
Enumeration date
05/07/2007
Last updated
09/24/2020
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