Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD24347 | OR |
NPI | 1124090634 |
---|---|
Provider Name | Dr. Brett I Gingold |
First Address | Bend, OR 97701-3887 |
Second Address | Bend, OR 97701-3730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 11/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
227040 | (05) | OR |
G96627 | (02) | OR |
P00013027 | RAILROAD MEDICARE (01) | OR |