Individual
KEN ROPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
55907 WOOD DUCK DR, BEND, OR 97707-2344
(541) 771-9542
Mailing address
55907 WOOD DUCK DR, BEND, OR 97707-2344
(541) 771-9542
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
1593248-4
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1593249-4
FEIN 46-4678412
OR
Enumeration date
02/13/2014
Last updated
02/13/2014
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