Healthcare Provider Details

I. General information

NPI: 1942633805
Provider Name (Legal Business Name): JASON FLAMIATOS M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 NE MEDICAL CENTER DR STE C
BEND OR
97701-3786
US

IV. Provider business mailing address

PO BOX 1517
PENDLETON OR
97801-0410
US

V. Phone/Fax

Practice location:
  • Phone: 541-322-5753
  • Fax: 541-278-8368
Mailing address:
  • Phone: 877-708-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number71864-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: