MEDICARE: DR. JOHN VINCENT PRIGNANO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	763	OR

General Provider Information

NPI Number	:	1700085792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN VINCENT PRIGNANO PH.D.

Provider Business Mailing Address
First Line	:	635 NW COLORADO AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-3257
Country	:	US
Telephone Number	:	541-388-8233
Fax Number	:	541-383-2993

Provider Business Practice Location Address
First Line	:	635 NW COLORADO AVE
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-3257
Country	:	US
Telephone Number	:	541-388-8233
Fax Number	:	541-383-2993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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