MEDICARE: NEUROLOGY OF BEND LLC

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	2084N0400X	Neurology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649314253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROLOGY OF BEND LLC

Provider Business Mailing Address
First Line	:	2421 NE DOCTORS DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6031
Country	:	US
Telephone Number	:	541-388-3311
Fax Number	:	541-389-1887

Provider Business Practice Location Address
First Line	:	2421 NE DOCTORS DR
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6031
Country	:	US
Telephone Number	:	541-388-3311
Fax Number	:	541-389-1887

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. GARY DAVID BUCHHOLZ
Credential	:	MD
Telephone Number	:	541-388-3311

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	12/04/2007

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Directions to “NEUROLOGY OF BEND LLC ” Practice Location

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