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General NPI Number Information
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NPI Number | 1124090634
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Entity Type | Individual
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Provider Name | BRETT I GINGOLD MD
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Gender | Male
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 2200 NE NEFF RD STE 200
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City | BEND
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State | OR
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Zip | 97701-4281
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Country | US
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Telephone | 541-382-3344
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Fax | 541-382-1681
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Provider Business Mailing Address
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Address Line | 1303 NE CUSHING DR SUITE 100
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City | BEND
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State | OR
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Zip | 97701-3887
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Country | US
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Telephone | 541-388-2333
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Fax |
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | MD24347
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License Number State | OR
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