Healthcare Provider Details

I. General information

NPI: 1740218353
Provider Name (Legal Business Name): C. BRUCE SCHWARTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CARL BRUCE SCHWARTZ MD

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 LONE PINE BLVD
THE DALLES OR
97058
US

IV. Provider business mailing address

PO BOX 1520
THE DALLES OR
97058
US

V. Phone/Fax

Practice location:
  • Phone: 541-506-6500
  • Fax: 541-296-6431
Mailing address:
  • Phone: 541-296-7668
  • Fax: 541-296-6431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number3570
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD08596
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: