Individual
MR. MICHAEL ARTHUR DE LA MATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSS
Contact information
Practice address
850 SE 4TH ST, MADRAS, OR 97741-9629
(541) 475-6575
Mailing address
PO BOX 1710, REDMOND, OR 97756-0516
(541) 504-9577
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000104906
OR
Other
Enumeration date
06/15/2023
Last updated
06/15/2023
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