Provider Demographics
NPI:1760429831
Name:MADSEN, BRUCE W (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:W
Last Name:MADSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2715 SW WILLETTA
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321
Mailing Address - Country:US
Mailing Address - Phone:541-926-5848
Mailing Address - Fax:541-926-2873
Practice Address - Street 1:2715 WILLETTA ST SW
Practice Address - Street 2:SUITE B
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-3471
Practice Address - Country:US
Practice Address - Phone:511-926-5848
Practice Address - Fax:541-926-2873
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD24375207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226939Medicaid
ORP00015670Medicare PIN
OR226939Medicaid
ORH83089Medicare UPIN
OR0648670001Medicare NSC