Provider Demographics
NPI:1073518551
Name:TIEN, RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:TIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 NE NETT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701
Mailing Address - Country:US
Mailing Address - Phone:541-382-3344
Mailing Address - Fax:541-382-1681
Practice Address - Street 1:2200 NE NETT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-382-3344
Practice Address - Fax:541-382-1681
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24627207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORM024627OtherOBME
OR227307Medicaid
H86565Medicare UPIN
OR118089Medicare ID - Type Unspecified