Basic Information
| Provider Information | |||||||||
| NPI: | 1255328787 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WINGE | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15090 FALL RIVER DR | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977072704 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 525 N SANTIAM HWY | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973554363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412582101 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01055695A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | MD161507 | OR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.