Provider Demographics
NPI:1750521126
Name:WETER, DON (BS,LMT, CNMT)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:WETER
Suffix:
Gender:M
Credentials:BS,LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 SW MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-2556
Mailing Address - Country:US
Mailing Address - Phone:503-705-0767
Mailing Address - Fax:
Practice Address - Street 1:1531 SW MARKET ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-2556
Practice Address - Country:US
Practice Address - Phone:503-705-0767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5734174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist