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Individual

MR. GERRY F FUNK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
710 SUNSET DR STE F, LA GRANDE, OR 97850
(541) 663-3100
(541) 975-5135
Mailing address
PO BOX 3290, LA GRANDE, OR 97850-7290
(541) 963-1967
(541) 963-1837

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
28198
IA
207Y00000X
Otolaryngology Physician
Primary
MD167147
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0073114
IA
01
04045
WELLMARK BCBS
IA
Enumeration date
10/28/2005
Last updated
07/24/2018
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