Healthcare Provider Details

I. General information

NPI: 1366601387
Provider Name (Legal Business Name): VICTOR A NWANGUMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 01/29/2023
Certification Date: 01/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 NE MEDICAL CENTER DR
BEND OR
97701-6051
US

IV. Provider business mailing address

1501 NE MEDICAL CENTER DR
BEND OR
97701-6051
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-6532
  • Fax:
Mailing address:
  • Phone: 541-706-6532
  • Fax: 888-719-1380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR51262
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberDR0051262
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: