Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD00034054 | WA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD201549 | OR |
NPI | 1225059439 |
---|---|
Provider Name | Patrick R Waber |
First Address | Bend, OR 97701-6015 |
Second Address | Bend, OR 97701-6015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 04/02/2021 |