Individual
RIO LION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
51600 HUNTINGTON RD, LA PINE, OR 97739-8887
(541) 536-3435
Mailing address
PO BOX 3300, LA PINE, OR 97739-3300
(541) 536-3435
(541) 536-8047
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO28237
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276263
—
OR
Enumeration date
05/31/2007
Last updated
10/19/2023
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