Provider Demographics
NPI:1770581415
Name:HOLMBOE, JEFFREY ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ARTHUR
Last Name:HOLMBOE
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 1:1303 NE CUSHING DR
Mailing Address - Street 2:STE 100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3887
Mailing Address - Country:US
Mailing Address - Phone:541-388-2333
Mailing Address - Fax:541-388-0930
Practice Address - Street 1:1303 NE CUSHING DR
Practice Address - Street 2:STE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3887
Practice Address - Country:US
Practice Address - Phone:541-388-2333
Practice Address - Fax:541-388-0930
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD16577207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR013552Medicaid
E57551Medicare UPIN
OR103322Medicare ID - Type Unspecified