Healthcare Provider Details

I. General information

NPI: 1568452589
Provider Name (Legal Business Name): CATHERINE RUTH SHELDON PLATT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 NE CUSHING DR STE 100
BEND OR
97701-3887
US

IV. Provider business mailing address

1303 NE CUSHING DR STE 100
BEND OR
97701-3887
US

V. Phone/Fax

Practice location:
  • Phone: 541-388-2333
  • Fax: 541-388-0930
Mailing address:
  • Phone: 541-388-2333
  • Fax: 541-388-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5124048-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101251137
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD184521
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: