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General NPI Number Information
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NPI Number | 1427510148
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Entity Type | Individual
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Provider Name | WILLEM O. SPEED MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 1140 SW SIMPSON AVE STE 110
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City | BEND
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State | OR
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Zip | 97702-3789
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Country | US
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Telephone | 541-389-7741
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1517
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City | PENDLETON
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State | OR
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Zip | 97801-0410
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Country | US
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Telephone | 877-708-1119
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Fax | 541-278-8349
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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 | 11898958-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 208512
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License Number State | OR
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