Douglas Vangordon

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

License

15-00002769 Issued in OR

Practice address

2245 NW Shevlin Park Rd
Bend, OR 97703-7195

Phone

(541) 382-3344

NPI assigned

Jun 2, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464825600000",
    "number": "1558719369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 NE NEFF RD",
            "address_2": "SUITE 200",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977014283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2245 NW SHEVLIN PARK RD",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977037195",
            "telephone_number": "541-382-3344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANGORDON",
        "first_name": "DOUGLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-02",
        "last_updated": "2016-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "OR",
            "license": "15-00002769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134170",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olivia Kathryn Vanderslice, PA-C
• John S Vandersteen, CRNA
• Mia Reese Vanderver
• Merrilen Jean Vandeweerd
• Kristin M Vandomelen, M.D.
• Patrick James Vangroll, M.A., CCC-A
• Blake Harrison Vanmeter, MD
• Kirsten Vantzelfden, CRM
• Elena Vargas
• Vanessa Kathleen Vargas, RD

• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Bend, OR
• Providers in Bend, OR by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.