Healthcare Provider Details

I. General information

NPI: 1467570077
Provider Name (Legal Business Name): UNIVERSITY OF OREGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1232 UNIVERSITY OF OREGON
EUGENE OR
97403-1205
US

IV. Provider business mailing address

1232 UNIVERSITY OF OREGON
EUGENE OR
97403-1205
US

V. Phone/Fax

Practice location:
  • Phone: 541-346-3572
  • Fax: 541-346-2747
Mailing address:
  • Phone: 541-346-3572
  • Fax: 541-346-2747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number936001786
License Number StateOR

VIII. Authorized Official

Name: RICHARD E BRUNADER
Title or Position: MEDICALDIRECTOR
Credential: MD
Phone: 541-346-4456