Provider Demographics
NPI:1700173218
Name:OLTMAN, JONAS H (DO)
Entity Type:Individual
Prefix:
First Name:JONAS
Middle Name:H
Last Name:OLTMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NW 11TH ST
Mailing Address - Street 2:SUITE E-15
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-8605
Mailing Address - Country:US
Mailing Address - Phone:541-567-6434
Mailing Address - Fax:541-429-6613
Practice Address - Street 1:600 NW 11TH ST
Practice Address - Street 2:SUITE E-15
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-8605
Practice Address - Country:US
Practice Address - Phone:541-567-6434
Practice Address - Fax:541-429-6613
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL4128207Q00000X
ORDO166841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500672677Medicaid
ORR175916OtherMEDICARE