Provider Demographics
NPI:1467443515
Name:FUNK, GERRY F (MD)
Entity Type:Individual
Prefix:MR
First Name:GERRY
Middle Name:F
Last Name:FUNK
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:PO BOX 3290
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-7290
Mailing Address - Country:US
Mailing Address - Phone:541-963-1967
Mailing Address - Fax:541-963-1837
Practice Address - Street 1:710 SUNSET DR STE F
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850
Practice Address - Country:US
Practice Address - Phone:541-663-3100
Practice Address - Fax:541-975-5135
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28198207Y00000X
ORMD167147207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04045OtherWELLMARK BCBS
IA0073114Medicaid
IA040004391Medicare PIN
IA04045OtherWELLMARK BCBS
IA0073114Medicaid