Individual
MICHAEL T LAVELLE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2200 NE NEFF RD, BEND, OR 97701-4283
(541) 548-7761
(541) 526-6554
Mailing address
PO BOX 6095, BEND, OR 97708-6095
(541) 706-5922
(541) 706-6869
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD25547
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277995
—
OR
Enumeration date
06/09/2006
Last updated
01/02/2024
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