Organization
BEND MEMORIAL CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY HAGFORS (CEO)
(541) 706-5401
Entity
Organization
Contact information
Practice address
2600 NE NEFF RD, BEND, OR 97701-6337
(541) 322-3504
Mailing address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231243
—
OR
Enumeration date
07/02/2008
Last updated
01/31/2012
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