# GLENN M KOTEEN M.D., LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Gastroenterology of Central Oregon
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407021348
- **Authorized official:** DR. GLENN M KOTEEN MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (541) 728-0535

## Contact information

- **Practice address:** 2450 NE MARY ROSE PL, STE 210, BEND, OR 97701-7132
- **Practice address phone:** (541) 728-0535
- **Practice address fax:** (541) 647-5125
- **Mailing address:** 2450 NE MARY ROSE PL, STE 210, BEND, OR 97701-7132
- **Mailing address phone:** (541) 728-0535
- **Mailing address fax:** (541) 647-5125

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | MD25338 | OR | Yes |

## Other

- **Enumeration date:** 04/22/2008
- **Last updated:** 11/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 022737 | — | OR |
| 01 | — | 120175 | MEDICARE \# | OR |