Provider Demographics
NPI:1780959973
Name:BRONNER, MORDECHAI J (MD)
Entity type:Individual
Prefix:DR
First Name:MORDECHAI
Middle Name:J
Last Name:BRONNER
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 1:2401 RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-5412
Mailing Address - Country:US
Mailing Address - Phone:541-344-8469
Mailing Address - Fax:541-687-8631
Practice Address - Street 1:2401 RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404
Practice Address - Country:US
Practice Address - Phone:541-344-8469
Practice Address - Fax:541-687-8631
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0013624207L00000X
390200000X
ORMD192339207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program