Provider Demographics
NPI:1114008687
Name:DEJUAN T SINGLETARY, LLC
Entity Type:Organization
Organization Name:DEJUAN T SINGLETARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEJUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGLETARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-382-1395
Mailing Address - Street 1:3439 NE SANDY BLVD
Mailing Address - Street 2:PMB 375
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1959
Mailing Address - Country:US
Mailing Address - Phone:503-284-8841
Mailing Address - Fax:503-282-3302
Practice Address - Street 1:2100 NE WYATT CT
Practice Address - Street 2:STE 202
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7702
Practice Address - Country:US
Practice Address - Phone:541-382-1395
Practice Address - Fax:541-382-6576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD262532084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH14616Medicare UPIN
ORR133983Medicare ID - Type Unspecified