Provider Demographics
NPI:1356304042
Name:HITTLE, GRETCHEN L (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:L
Last Name:HITTLE
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 1:14829 NE COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OR
Mailing Address - Zip Code:97002-9503
Mailing Address - Country:US
Mailing Address - Phone:971-506-1265
Mailing Address - Fax:
Practice Address - Street 1:14829 NE COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OR
Practice Address - Zip Code:97002-9503
Practice Address - Country:US
Practice Address - Phone:971-506-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR66733Medicaid
OR66733Medicaid
F91847Medicare UPIN