Provider Demographics
NPI:1790974202
Name:UNTERSEHER, BENJAMIN (LMT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:UNTERSEHER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 NE MCDANIEL LN
Mailing Address - Street 2:AVE #A
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3247
Mailing Address - Country:US
Mailing Address - Phone:503-472-2523
Mailing Address - Fax:
Practice Address - Street 1:2270 NE MCDANIEL LN
Practice Address - Street 2:AVE #A
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3247
Practice Address - Country:US
Practice Address - Phone:503-472-2523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101946172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker