Healthcare Provider Details

I. General information

NPI: 1245058114
Provider Name (Legal Business Name): ALPENAURA PLASTIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 NE DOCTORS DR STE 1
BEND OR
97701-6324
US

IV. Provider business mailing address

1382 NE DROST DR
BEND OR
97701-3707
US

V. Phone/Fax

Practice location:
  • Phone: 541-762-0262
  • Fax:
Mailing address:
  • Phone: 214-802-8297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. JOURDAN ARISS CARBOY
Title or Position: PHYSICIAN BUSINESS OWNER
Credential: MD
Phone: 541-762-0262