Healthcare Provider Details

I. General information

NPI: 1396659488
Provider Name (Legal Business Name): INTEGRATIVE FAMILY MEDICINE OF BEND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 NE MARY ROSE PL STE 220
BEND OR
97701-7133
US

IV. Provider business mailing address

2450 NE MARY ROSE PL STE 220
BEND OR
97701-7133
US

V. Phone/Fax

Practice location:
  • Phone: 541-848-6152
  • Fax: 541-572-9042
Mailing address:
  • Phone: 541-848-6152
  • Fax: 541-572-9042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOCELYN COOPER
Title or Position: OWNER/PHYSICIAN
Credential: ND
Phone: 541-848-6152