Provider Demographics
NPI:1831152982
Name:TRETHEWAY, DAVID MARTIN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARTIN
Last Name:TRETHEWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 SW REINDEER AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-9449
Mailing Address - Country:US
Mailing Address - Phone:541-548-4088
Mailing Address - Fax:541-548-3732
Practice Address - Street 1:236 NW KINGWOOD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1324
Practice Address - Country:US
Practice Address - Phone:541-548-7134
Practice Address - Fax:541-548-7196
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14982207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR108240Medicare PIN
ORA07518Medicare UPIN