Individual
SCOUT FALLON GREGERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Mailing address
1991 NW MONTEREY PINES DR, BEND, OR 97703-5281
(507) 301-8546
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA217307
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500825590
—
OR
Enumeration date
10/06/2023
Last updated
08/11/2024
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