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General NPI Number Information
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NPI Number | 1033645296
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Entity Type | Individual
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Provider Name | RYAN DANIEL LURTSEMA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2017
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Last Update Date | 08/11/2024
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Provider Practice Location Address
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Address Line | 1501 NE MEDICAL CENTER DR
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City | BEND
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State | OR
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Zip | 97701-6051
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Country | US
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Telephone | 541-382-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 3601 4TH STREET MAIL STOP 9901
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City | LUBBOCK
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State | TX
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Zip | 79430-0002
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Country | US
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Telephone | 806-743-2757
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Fax | 806-743-1180
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD218786
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | R8935
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R8935
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License Number State | TX
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