Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD24627 | OR |
NPI | 1073518551 |
---|---|
Provider Name | Raymond Tien |
First Address | Bend, OR 97701 |
Second Address | Bend, OR 97701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 01/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
227307 | (05) | OR |
H86565 | (02) | |
M024627 | OBME (01) | OR |