Provider Demographics
NPI:1316387251
Name:FAAST, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:FAAST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 NE MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6061
Mailing Address - Country:US
Mailing Address - Phone:541-382-6633
Mailing Address - Fax:541-382-2719
Practice Address - Street 1:1460 NE MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6061
Practice Address - Country:US
Practice Address - Phone:541-382-6633
Practice Address - Fax:541-382-2719
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1977622085R0202X
NMRS2015-0372390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD197762OtherMEDICAL LICENSE