Healthcare Provider Details

I. General information

NPI: 1336264373
Provider Name (Legal Business Name): OSVALDO A. SCHIRRIPA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 SW SHEVLIN HIXON DR SUITE #203
BEND OR
97702-3189
US

IV. Provider business mailing address

143 SW SHEVLIN HIXON DR SUITE #203
BEND OR
97702-3189
US

V. Phone/Fax

Practice location:
  • Phone: 541-633-7172
  • Fax:
Mailing address:
  • Phone: 541-633-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA46201
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License NumberMD153157
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License NumberMD153157
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number39144
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number39144
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: