Healthcare Provider Details

I. General information

NPI: 1750342010
Provider Name (Legal Business Name): DAVID T SCHLOESSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 NE CONNERS AVE
BEND OR
97701-6068
US

IV. Provider business mailing address

2349 NE CONNERS AVE
BEND OR
97701-6068
US

V. Phone/Fax

Practice location:
  • Phone: 541-317-0044
  • Fax: 541-728-0707
Mailing address:
  • Phone: 541-317-0044
  • Fax: 541-728-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD22475
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier288424
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: