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Individual

EDWARD L VAN TASSEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
2200 BRYANT WILLIAMS DRIVE, SUITE 1, KLAMATH FALLS, OR 97601-1120
(541) 884-7746
(541) 884-0848
Mailing address
2200 BRYANT WILLIAMS DRIVE, SUITE 1, KLAMATH FALLS, OR 97601-1120
(541) 884-7746
(541) 884-0848

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
DO25890
OR
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
DO25890
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
20889454297601
TRICARE
OR
05
213618
OR
01
820591000
BLUE CROSS
OR
01
P00419803
RAIL ROAD MEDICARE
OR
01
P00464722
RAIL ROAD MEDICARE
OR
01
XPY145960
MEDI-CAL
CA
Enumeration date
07/25/2006
Last updated
03/07/2023
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