Healthcare Provider Details

I. General information

NPI: 1164406179
Provider Name (Legal Business Name): BARBARA JEAN LARGENT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 NW KINGSTON AVE
BEND OR
97701-2242
US

IV. Provider business mailing address

1375 NW KINGSTON AVE
BEND OR
97701-2242
US

V. Phone/Fax

Practice location:
  • Phone: 541-383-5958
  • Fax: 541-383-3016
Mailing address:
  • Phone: 541-383-5958
  • Fax: 541-383-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20016
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: