Organization Name: | LIFESTYLE MEDICINE OF CENTRAL OREGON, PC |
NPI Number: | 1013264456 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY HUNTSMAN (OWNER) |
Mailing Address: | 497 Sw Century Dr Suite 120 Bend |
State: | OR US |
Postal Code: | 977021167 |
Phone Number: | 5412919960 |
Fax Number: | 5412919961 |
NPI Enumeration Date: | 08/03/2012 |
NPI Last Update Date: | 04/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207VG0400X |
License Number: | MD17360 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | Gynecology |
Taxonomy Definition: |