Healthcare Provider Details

I. General information

NPI: 1760464812
Provider Name (Legal Business Name): JEAN S VERHEYDEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 NE MARY ROSE PL SUITE 120
BEND OR
97701-7132
US

IV. Provider business mailing address

2450 NE MARY ROSE PL SUITE 120
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 Number25065
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License NumberMD25065
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: