MEDICARE: SKYLAR DOUGLAS LE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246Z00000X	Other Specialist/Technologist	BAP-E-10266881	OR

General Provider Information

NPI Number	:	1376481192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYLAR DOUGLAS LE

Provider Business Mailing Address
First Line	:	2669 NE TWIN KNOLLS DR # 110
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4895
Country	:	US
Telephone Number	:	541-241-7412
Fax Number	:

Provider Business Practice Location Address
First Line	:	2669 NE TWIN KNOLLS DR # 110
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-4895
Country	:	US
Telephone Number	:	541-241-7412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ SKYLAR DOUGLAS LE” Practice Location

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