Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD15503 | OR |
N | 111NI0900X | Internist | MD15503 | OR |
N | 207RC0000X | Internist - Cardiovascular Disease | MD15503 | OR |
Y | 207RI0011X | Interventional Cardiology | MD15503 | OR |
NPI | 1043290398 |
---|---|
Provider Name | Bruce A Mclellan |
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 | 20/01/2006 |
Last Update Date | 17/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
208371 | (05) | OR |
A51682 | (02) | OR |