Provider Demographics
NPI:1003235474
Name:WOHLETZ, BETHANY (MD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:WOHLETZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 WALLACE RD NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3116
Mailing Address - Country:US
Mailing Address - Phone:503-304-5716
Mailing Address - Fax:503-304-5719
Practice Address - Street 1:1160 WALLACE RD NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3116
Practice Address - Country:US
Practice Address - Phone:503-304-5716
Practice Address - Fax:503-304-5719
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD.MD.60762477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty