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General NPI Number Information
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NPI Number | 1043653777
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Entity Type | Organization
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Legal Business Name | GARY D BUCHHOLZ MD PC
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Dates
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Enumeration Date | 04/11/2013
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 2275 NE DOCTORS DR SUITE 9
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City | BEND
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State | OR
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Zip | 97701-6324
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Country | US
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Telephone | 541-706-5460
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Fax | 541-706-9282
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Provider Business Mailing Address
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Address Line | 2275 NE DOCTORS DR SUITE 9
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City | BEND
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State | OR
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Zip | 97701-6324
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Country | US
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Telephone | 541-706-5460
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Fax | 541-706-9282
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY D BUCHHOLZ
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Credential | MD
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Telephone | 541-706-5460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | MD14593
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License Number State | OR
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