Individual
WILLIE UNDERWOOD III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1247 NE MEDICAL CENTER DR STE C, BEND, OR 97701-3786
(541) 322-5753
(541) 278-8368
Mailing address
PO BOX 1517, PENDLETON, OR 97801-0410
(877) 708-1119
(541) 278-8349
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
250131
NY
208800000X
Urology Physician
Primary
MD214003
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03038759
—
NY
Enumeration date
05/31/2006
Last updated
12/21/2022
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