Healthcare Provider Details

I. General information

NPI: 1851503940
Provider Name (Legal Business Name): DAMIAN P VRANIAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

649 NW COMPASS LN
BEND OR
97701-6942
US

IV. Provider business mailing address

649 NW COMPASS LN
BEND OR
97701-6942
US

V. Phone/Fax

Practice location:
  • Phone: 303-335-5627
  • Fax:
Mailing address:
  • Phone: 303-335-5627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD150576
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: