MEDICARE: PATRICK MICHAEL NEARING D.M.D.

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	122300000X	Dentist	5543	OR

General Provider Information

NPI Number	:	1437300514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK MICHAEL NEARING D.M.D.

Provider Business Mailing Address
First Line	:	1614 5TH ST
Second Line	:
City	:	LA GRANDE
State	:	OR
Zip	:	97850-2516
Country	:	US
Telephone Number	:	541-963-8585
Fax Number	:	541-963-6633

Provider Business Practice Location Address
First Line	:	1614 5TH ST
Second Line	:
City	:	LA GRANDE
State	:	OR
Zip	:	97850-2516
Country	:	US
Telephone Number	:	541-963-8585
Fax Number	:	541-963-6633

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

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	10/07/2008

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