Mary Angela Dallas, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

93286 Issued in NM

Practice address

2500 NE Neff Rd
St. Charles Medical Group
Bend, OR 97701-6015

Phone

(541) 526-6556

Fax

(541) 706-3765

NPI assigned

Oct 3, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294790400000",
    "number": "1568556934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1420",
            "address_2": "ST. CHARLES MEDICAL GROUP",
            "city": "REDMOND",
            "state": "OR",
            "postal_code": "977560400",
            "telephone_number": "541-526-6556",
            "fax_number": "541-706-3765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 NE NEFF RD",
            "address_2": "ST. CHARLES MEDICAL GROUP",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977016015",
            "telephone_number": "541-526-6556",
            "fax_number": "541-706-3765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALLAS",
        "first_name": "MARY",
        "middle_name": "ANGELA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2011-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD153008",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NM",
            "license": "93286",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8785",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• D'Arcy Swanson Inc.
• Laurie Cordaro D'Avignon, M.D.
• Louis M D'Avignon, MD
• Meagan C Dahl, PT
• William Dai, PHARM.D
• Ella Daly, LMT
• Shannon Suzanne Dames, RN
• Mary Kathleen Dammarell, RN
• Stewart Dandorf
• Christen Danford

• Internal Medicine Physician in Bend, OR
• Providers in Bend, OR by specialty
• Internal Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2011; 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.