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Organization

GLENN M KOTEEN M.D., LLC

Active
Other names
Gastroenterology of Central Oregon
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GLENN M KOTEEN MD (OWNER/PHYSICIAN)
(541) 728-0535
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
MD25338
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
022737
OR
01
120175
MEDICARE #
OR
Enumeration date
04/22/2008
Last updated
11/14/2008
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