Provider Demographics
NPI:1588601892
Name:HOUSE, THERESA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:LYNN
Last Name:HOUSE
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 1:2295 COBURG RD STE 301
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7482
Mailing Address - Country:US
Mailing Address - Phone:541-233-4766
Mailing Address - Fax:541-833-5468
Practice Address - Street 1:2295 COBURG RD STE 301
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-7482
Practice Address - Country:US
Practice Address - Phone:541-233-4766
Practice Address - Fax:541-833-5468
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080770Medicaid
OR080770Medicaid
00WFBKPCMedicare ID - Type Unspecified