# PONDEROSA MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710931274
- **Authorized official:** GILBERT B LEE MD (PHYSICIAN)
- **Authorized official phone:** (541) 312-8679

## Contact information

- **Practice address:** 1558 SW NANCY WAY, SUITE 101, BEND, OR 97702-3216
- **Practice address phone:** (541) 312-8679
- **Mailing address:** 1558 SW NANCY WAY, SUITE 101, BEND, OR 97702-3216
- **Mailing address phone:** (541) 312-8679

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | MD12002 | OR | Yes |

## Other

- **Enumeration date:** 05/20/2006
- **Last updated:** 08/22/2020