Healthcare Provider Details

I. General information

NPI: 1831149079
Provider Name (Legal Business Name): TIMOTHY KRIGBAUM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 NW 4TH ST STE A
REDMOND OR
97756-1328
US

IV. Provider business mailing address

2090 NE WYATT CT SUITE 101
BEND OR
97701-7687
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-7761
  • Fax: 541-598-3485
Mailing address:
  • Phone: 541-382-6447
  • Fax: 541-330-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00998
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: