Provider Demographics
NPI:1619982030
Name:AMEND, ERIC KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:KENNETH
Last Name:AMEND
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 1:213 NW LARCH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-1323
Mailing Address - Country:US
Mailing Address - Phone:541-526-6635
Mailing Address - Fax:541-526-6636
Practice Address - Street 1:213 NW LARCH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-1323
Practice Address - Country:US
Practice Address - Phone:541-526-6635
Practice Address - Fax:541-526-6636
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD26713174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCGBDMedicare ID - Type UnspecifiedBAY CLINIC, LLP