Healthcare Provider Details

I. General information

NPI: 1255113429
Provider Name (Legal Business Name): MICHAEL KEITH DEFORD NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 RIVERBEND DR
SPRINGFIELD OR
97477-8800
US

IV. Provider business mailing address

1213 E 3RD ST
LOVELAND CO
80537-5813
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-7300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number10016237
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: