Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0122X | Plastic and Reconstructive Surgery | GO78756 | CA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD26066 | OR |
NPI | 1336209345 |
---|---|
Provider Name | Dr. Adam Peter Angeles |
First Address | Bend, OR 97701-4192 |
Second Address | Bend, OR 97701-4192 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I41623 | (02) | OR |