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General NPI Number Information
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NPI Number | 1881779635
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Entity Type | Individual
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Provider Name | MARY ELLEN COULTER MD
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 550 NW HILL ST
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City | BEND
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State | OR
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Zip | 97701-2951
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Country | US
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Telephone | 541-312-4426
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Fax | 541-312-8010
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Provider Business Mailing Address
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Address Line | 1940 NW MONTEREY PINES DR #4
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City | BEND
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State | OR
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Zip | 97701-5288
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Country | US
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Telephone | 541-390-8135
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Fax | 541-390-8010
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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 | 13437
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License Number State | OR
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