Healthcare Provider Details

I. General information

NPI: 1235267303
Provider Name (Legal Business Name): DESERT BONE & JOINT SPECIALISTS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/29/2018
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 Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 11
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1457851586
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNPI
# 2
Identifier192931300
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerOWCP
# 3
Identifier1158800001
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerDME
# 4
Identifier1518468644
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerNPI
# 5
Identifier149991
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name: KACI WILLIAMS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 541-388-2333