Healthcare Provider Details

I. General information

NPI: 1861508632
Provider Name (Legal Business Name): M. JAMIE MCALLISTER, D. O., P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 NE IRVING AVE.
BEND OR
97701-4738
US

IV. Provider business mailing address

711 NE IRVING AVE.
BEND OR
97701-4738
US

V. Phone/Fax

Practice location:
  • Phone: 541-330-9110
  • Fax: 541-330-9112
Mailing address:
  • Phone: 541-330-9110
  • Fax: 541-330-9112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberDO17061
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARY JAMES MCALLISTER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 541-330-9110