Provider Demographics
NPI:1952459356
Name:HUNTSMAN, MARY NORBURG (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:NORBURG
Last Name:HUNTSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:NORBURG
Other - Last Name:HUNTSMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:61145 MINARET CIR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1997
Mailing Address - Country:US
Mailing Address - Phone:541-317-9390
Mailing Address - Fax:
Practice Address - Street 1:497 SW CENTURY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1167
Practice Address - Country:US
Practice Address - Phone:541-516-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2013-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17360207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORFO7003Medicare UPIN