Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD16748 | OR |
NPI | 1043237084 |
---|---|
Provider Name | Angelo A Vlessis |
First Address | Bend, OR 97708-5579 |
Second Address | Bend, OR 97701-6015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 22/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150257 | (05) | OR |