Healthcare Provider Details

I. General information

NPI: 1750590238
Provider Name (Legal Business Name): JUSTIN D HILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 NE MARY ROSE PL
BEND OR
97701-7132
US

IV. Provider business mailing address

2450 NE MARY ROSE PL
BEND OR
97701-7132
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-3100
  • Fax: 541-312-7050
Mailing address:
  • Phone: 541-382-3100
  • Fax: 541-312-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberR7138
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number37840
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number37840
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number37840
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: