Provider Demographics
NPI:1487873097
Name:DOOLITTLE, CHARLES HERBERT III (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HERBERT
Last Name:DOOLITTLE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:543 SERENITY LN
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-9795
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6464 SW BORLAND RD
Practice Address - Street 2:SUITE C-5
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8876
Practice Address - Country:US
Practice Address - Phone:503-692-3636
Practice Address - Fax:503-692-5019
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20875207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR129998Medicaid
OR129998Medicaid
ORG84635Medicare UPIN