Provider Demographics
NPI:1467512996
Name:WILLAMETTE UROLOGY, PC
Entity Type:Organization
Organization Name:WILLAMETTE UROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MHOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-561-7100
Mailing Address - Street 1:2973 12TH STREET SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6162
Mailing Address - Country:US
Mailing Address - Phone:503-561-7100
Mailing Address - Fax:503-561-7124
Practice Address - Street 1:2973 12TH STREET SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6162
Practice Address - Country:US
Practice Address - Phone:503-561-7100
Practice Address - Fax:503-561-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty