Healthcare Provider Details

I. General information

NPI: 1801940499
Provider Name (Legal Business Name): GURPREET CHOPRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 NW WALL ST SUITE #200
BEND OR
97701-1972
US

IV. Provider business mailing address

1345 NW WALL ST SUITE #200
BEND OR
97701-1972
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-1395
  • Fax: 541-382-6576
Mailing address:
  • Phone: 541-382-1395
  • Fax: 541-382-6576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD28897
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: