Individual
IVAN NICOLAS VIAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2450 NE MARY ROSE PL STE 201, BEND, OR 97701-7133
(541) 317-0808
Mailing address
2450 NE MARY ROSE PL, STE 201, BEND, OR 97701
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
MD180009
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500719243
—
OR
Enumeration date
07/03/2011
Last updated
06/11/2019
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