Individual
TAJYANT NAT CHOTECHUANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1510 SW NANCY WAY STE 2, BEND, OR 97702-3256
(541) 385-7129
(541) 385-7138
Mailing address
1510 SW NANCY WAY STE 2, BEND, OR 97702-3256
(541) 385-7129
(541) 385-7138
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DP00339
OR
213ES0103X
Foot & Ankle Surgery Podiatrist
DP00339
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181419
—
OR
01
—
20-2456582
TAX ID
OR
01
—
865318005
BLUE CROSS
OR
Enumeration date
08/13/2006
Last updated
07/22/2011
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