Healthcare Provider Details

I. General information

NPI: 1528046455
Provider Name (Legal Business Name): DAVID M STRUTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 COUNTRY CLUB RD STE 200A
EUGENE OR
97401-6024
US

IV. Provider business mailing address

929 SW SIMPSON AVE SUITE 300
BEND OR
97702-3599
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-2134
  • Fax: 541-686-6021
Mailing address:
  • Phone: 541-389-7741
  • Fax: 541-278-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD13948
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier101204
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: