Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | M5808 | TX |
Y | 2084N0400X | Neurologist | MD185769 | OR |
N | 2084N0600X | Clinical Neurophysiologist | M5808 | TX |
NPI | 1033230800 |
---|---|
Provider Name | Jeremiah W Lanford |
First Address | Bend, OR 97709-0670 |
Second Address | Bend, OR 97701-7133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 22/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD185769 | STATE LICENSE (01) | OR |