Provider Demographics
NPI:1508963125
Name:SCHETTLER HUBERTY, ERIKA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:ELIZABETH
Last Name:SCHETTLER HUBERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:ELIZABETH
Other - Last Name:SCHETTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17704 JEAN WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-699-0370
Mailing Address - Fax:971-236-9099
Practice Address - Street 1:17704 JEAN WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-699-0370
Practice Address - Fax:971-236-9099
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26956207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR028558Medicaid
OR135413Medicare PIN
ORI40653Medicare UPIN